VIRAL-DNA IN MICRODISSECTED RENAL BIOPSY-TISSUE FROM HIV-INFECTED PATIENTS WITH NEPHROTIC SYNDROME

Focal glomerulosclerosis (FGS) has been considered as HIV-associated n ephropathy, a specific renal complication of infection. To determine w hether renal disease in HIV infected patients has one highly prevalent pathologic expression, and whether renal parenchymal viral genomic in corporation affects pathologic outcome, we reviewed renal biopsies per formed at our center. Twenty-eight HIV infected patients with nephroti c range proteinuria underwent renal biopsy for diagnosis of renal dise ase; 85.7% led homosexual or bisexual lifestyles; 10.7% admitted to in travenous drug use; and 85.7% were Black. Only 53.6% had FGS; 28.6% ha d glomerulonephritis. Two patients had diabetic renal disease; 93.3% o f patients with FGS and 87.5% of patients with glomerulonephritis were Black. Paraffin slides of twenty-two of the patients' renal biopsies were evaluated by polymerase chain reaction (PCR) for the presence of HIV DNA, using primers and probes to the gag gene, detected by liquid hybridization and polyacrylamide gel electrophoresis. Twenty-one of th e twenty-two evaluated tissue specimens showed the presence of HIV DNA . Microdissection studies of glomeruli, tubules, interstitial cells an d infiltrating inflammatory cells showed the presence of HIV genome in all but interstitial cells. HIV infected patients without renal disea se also had positive PCR evaluations of microdissected tissue, while n on-infected patients were all negative. We conclude that although foca l glomerulosclerosis is the most common renal pathologic lesion in pat ients with HIV infection and nephrotic range proteinuria, glomerulonep hritis is a relatively frequent finding. HIV genome is present in rena l tissue in HIV infected subjects with nephrotic range proteinuria, bu t is also found in HIV infected subjects without nephropathy. These da ta suggest a triggering mechanism may be crucial to the pathogenesis o f nephropathy in HIV infected patients. Renal biopsy is essential to e stablishing the diagnosis of HIV-associated renal disease in this hete rogeneous syndrome. The role of renal HIV infection, the cell types af fected, and influence on pathogenesis of renal disease remain to be de termined.