Prevalence of HIV-associated nephropathy in autopsies of HIV-infected patients

Previous studies have reported that approximately 10% of the patients with human immunodeficiency virus (HIV) infection develop HIV-associated nephrop athy (HIVAN). However, over the last decade, morbidity and mortality as a r esult of HIV-1 infection has remarkably decreased with the availability of potent new antiretroviral drugs. We therefore determined the prevalence of HIVAN from autopsy data of HIV-infected patients in more recent years (1992 to 1997). Autopsy reports of 389 patients were reviewed. In reports sugges tive of possible HIVAN, slides of renal tissue were retrieved and reviewed again to ensure appropriate classification. The criteria for the diagnosis of HIVAN were focal segmental glomerulosclerosis with collapse of the glome rular tuft in some glomeruli, extensive tubular ectasia, and significant tu bulointerstitial disease. Of 389 autopsy reports, 54% of the patients were black, 35% were white, and 11% were Hispanic. Thirty-three percent of the p atients had a history of Intravenous drug abuse. The mean CD4 count of the patients was 54 +/- 91/mu L (mean +/- SD). In 27 cases, typical features of HIVAN were found based on the criteria used, accounting for an overall HIV AN prevalence of 6.9% (27 of 389 autopsies). Because the overwhelming major ity of these patients were black (93%), the prevalence in blacks was 12% (2 5 of 209 autopsies). We conclude that although mortality and morbidity from HIV infection is decreasing, HIVAN remains an important complication of HI V infection in blacks, even in recent years. (C) 2000 by the National Kidne y Foundation, Inc.