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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

HIV-associated nephropathy (HIV-N) is considered a distinctive disease, the pathogenesis of which is still undefined. Direct virus-induced renal cell damage has been postulated. The numerous cytolytic ultrastructural changes and a few studies by immunoperoxidase support this hypothesis, but there has been no demonstration of virus by electron-microscopy (EM) or by tissue culture. In seven out of 12 cases with histological characteristics of HIV nephropathy, with proteinuria (five cases) or with nephrotic syndrome (two cases), we tested renal tissue for HIV antigens: core p18 and p25; envelope gp45 and gp110, by means of immunoperoxidase avidin-biotin complex monoclonal antibodies (MoAbs). Light-microscopy (LM) showed in five patients a focal and segmental glomerular sclerosis, and in two a mesangial hyperplasia with vacuolisation of visceral epithelium and protein inclusions. Electron-microscopy, performed in five of seven patients, showed several protein inclusions in podocyte cytoplasm, tubuloreticular inclusions in endothelial cell cytoplasm in all cases, nuclear degranulation of tubular cells in four cases and nuclear bodies in two. HIV antigens by MoAbs on renal tissue were negative in all cases, in both glomeruli and tubules. These results do not confirm the presence of HIV proteins in renal tissue of patients with HIV nephropathy. A possible explanation, apart from no direct HIV in the disease, may be the low viral load in tissues, because of the early phases of renal damage in most cases.
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PMID:Absence of HIV antigens in renal tissue from patients with HIV-associated nephropathy. 213 Feb 92

A 31-year-old HIV-1-seropositive Haitian male presented with HIV-nephropathy and typical features of subcortical dementia. He died 4 months after the onset of neurological signs. Neuropathological examination revealed HIV encephalitis with diffuse progressive leukoencephalopathy, diffuse poliodystrophy and massive calcifications of white matter, basal ganglia and dentate nuclei probably partly related to renal failure. It was associated with focal, subependymal CMV encephalitis. In the periventricular regions, morphologically characteristic multinucleated giant cells, positive for CD68, and negative for GFAP, contained early CMV antigens (E13) in their nuclei and HIV antigens (gp41 and p24) in their cytoplasm. The co-infection of a single cell by both viruses was confirmed by electron microscopy. The finding that HIV and CMV can co-infect in vivo the same cell raises the question of a direct cooperation of both viruses at the single cell level, and suggests the possibility of a role for CMV as co-factor in the pathogenesis of HIV encephalopathy.
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PMID:[Cytomegalovirus (CMV) and human immunodeficiency virus (HIV) co-infection, of multinucleated giant cells in acquired immunodeficiency syndrome (AIDS) encephalopathy]. 217 65

This article has provided an overview of the effects of HIV on renal function. Most transmission of the virus occurs by sexual, blood, and perinatal contact. CD-4 positive cells, especially those that are integral components of the immune system, serve as the reservoir for the reproduction of the virus. The resulting effect is destruction of the immune system with eventual multisystem failure and death. Renal complications arise from several factors, notably the compounding effects of chronic dehydration, malnutrition, infection, and use of nephrotic agents. Acute renal complication can be reversible with prompt assessment, and management directed at maintaining hydration, preventing sepsis, and carefully monitoring drugs. A chronic, irreversible renal disease in HIV is due, in large part, to a syndrome known as AIDS nephropathy, characterized by glomerular sclerosis and nephrotic-type symptoms, which ultimately lead to the need for dialysis. Aids nephropathy is seen most often in intravenous drug users, Haitians, and blacks with HIV. End-stage disease complicates the course of HIV and contributes to early mortality. A small, but significant number of renal patients acquires HIV infection as a result of multiple blood transfusions or through organ donation. Concentrated exposure to blood and body fluid during dialysis necessitates implementation of meticulous infection control procedures to protect both staff and patients. Guidelines by the CDC suggest that universal precautions adequate to prevent the spread of hepatitis B will suffice for HIV as well. HIV infection presents special challenges for those involved with renal management. Prevention and management of renal complication are made possible by thorough understanding of the complex network and interaction of the disease process.
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PMID:Renal system complications in HIV infection. 219 22

Initial autopsy studies concerned primarily with the systemic manifestations of the acquired immunodeficiency syndrome (AIDS) did not indicate that significant renal problems were likely to occur in AIDS patients. However, several recent studies have suggested that important renal and electrolyte disorders develop frequently in at least some groups of AIDS patients. In this report, we review current information concerning such disorders and describe our study of the frequency and types of renal lesions in the first 50 AIDS patients undergoing autopsy at this institution. We conclude that a number of renal lesions and electrolyte abnormalities occur in AIDS patients, although the frequency and nature of these problems vary considerably from center to center. Studies from several centers, including our own, indicate that AIDS patients are particularly likely to develop tubulointerstitial lesions (such as nephrocalcinosis and interstitial nephritis) and electrolyte disorders. Additional studies from specific centers in New York City, Miami, Detroit, and Los Angeles indicate that AIDS patients can also develop glomerular lesions, including a variant of focal and segmental glomerulosclerosis (FSGS) associated with heavy proteinuria and rapidly progressive renal failure. Although FSGS is not commonly observed in all centers, AIDS patients with this lesion appear to have a distinctive combination of clinical and pathological features, suggesting that they have a specific "human immunodeficiency virus (HIV)-associated" nephropathy. Preliminary evidence suggests that this lesion may be related to direct renal HIV infection, although confirmation of this possibility is needed. The approach to the AIDS patient with renal disease should involve correction of reversible disorders and consideration of dialysis as necessary.
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PMID:Acquired immunodeficiency syndrome and the kidney. 219 75

The AIDS epidemic is growing worldwide, and projections for the next decade indicate that over 6 million people will develop clinical AIDS, an increase of 10-30 times the number that has been reported to date. AIDS is spreading rapidly among intravenous drug abusers, which is the risk group that is at highest risk for the development of HIV associated nephropathy (HIVAN). This will result in an increase in the number of patients who develop end stage renal disease (ESRD) and require dialysis treatment during the next decade. Survival time for patients with AIDS is improving as new therapies are implemented; the prognosis for patients with AIDS and ESRD also appears to be slightly better, but the natural course of HIV infection in the ESRD patient remains to be defined.
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PMID:Renal disease and HIV infection: clinical course, treatment outcome, and infection control. 231 3

A spectrum of renal abnormalities has been described in patients infected with the human immunodeficiency virus (HIV) with or without signs of the acquired immunodeficiency syndrome (AIDS). In particular, attention has been focused on a nephropathy characterized clinically by nephrotic proteinuria and rapidly advancing renal insufficiency, and histologically by focal and segmental glomerulosclerosis (FSGS). To evaluate the relationship between HIV infection and structural renal disease, we reviewed all consultations between January 1982 and March 1988 to the Division of Nephrology at San Francisco General Hospital (SFGH), a municipal hospital treating approximately one-third of AIDS cases in San Francisco. Seventy-three consultation requests were received during this period regarding patients with AIDS (48), AIDS-Related Complex (23), or asymptomatic HIV infection (2). Of these, 27 gave evidence of structural renal disease (Group I): 14 had chronic renal insufficiency, in 10 of whom nephrotic proteinuria was also present. However, progression of renal insufficiency to end-stage renal disease (ESRD) in this group did not follow the rapid course described for HIV-associated nephropathy. Renal tissue was examined in 11 Group I patients and showed FSGS in four and a variety of acute and chronic glomerular and tubulointerstitial changes in the others. In 46 Group II patients, consultation was requested for acute renal failure or fluid, electrolyte, and acid-base disturbances. We also reviewed 91 consecutive autopsies performed in patients dying with AIDS at SFGH between 1981 and 1986.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal involvement in patients infected with HIV: experience at San Francisco General Hospital. 234 28

Hepatitis B vaccination programs have prevented infection in many dialysis patients, although the antibody response to vaccination is still insufficient in approximately 50%. Reinfection or reactivation of latent hepatitis B infection (HBV) has been reported in certain groups of immunosuppressed patients, including those infected with the human immunodeficiency virus (HIV-1). We report the reactivation or reinfection of HBV with resurgence of hepatitis B surface antigen in a dialysis patient coinfected with HIV-1. Thus, in dialysis patients with latent HBV infection, with undetectable hepatitis B surface antigen (HBsAg) levels, the potential exists to reactivate during immunosuppression associated with HIV-1 infection and/or end-stage renal disease. Reinfection with a different subtype is also possible. The development of hepatitis B surface antigenemia in this patient population creates a potential for transmission in the dialysis setting. This is of special concern since the number of patients infected with HIV-1 and with evidence of prior hepatitis B infection is increasing in urban units.
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PMID:Recurrence and clearance of hepatitis B surface antigenemia in a dialysis patient infected with the human immunodeficiency virus. 238 53

Since the first report on the acquired immunodeficiency syndrome (AIDS) in 1981, organ involvement of AIDS has increased. We discuss the effect of human immunodeficiency virus (HIV) infection, the causative agent of AIDS, on the field of nephrology. Hyponatremia, the commonest fluid and electrolyte abnormality, is caused by various pathophysiologic mechanisms, including adrenal insufficiency. The renal parenchymal complications are diverse, but a new entity, HIV-associated nephropathy, is becoming recognized because of its characteristic clinical and pathologic features, including the fact that it causes irreversible renal failure. HIV infection in patients with end-stage renal failure, both before and after initiation of maintenance dialysis, is a significant problem. The present methods of preventing spread of virus in dialysis units seem successful. Few patients who are infected with HIV or who have AIDS have had renal transplantation, although unsuspected viral infection of cadaveric organs remains a concern.
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PMID:Human immunodeficiency virus (HIV) infection and the kidney. 240 74

Urine and peripheral blood samples from 48 human immunodeficiency virus type 1 (HIV-1) seropositive individuals (38 adults and 10 children) were evaluated for the presence of HIV-1 by cocultivation and for HIV-1 p24 antigen by ELISA. None of the urine samples contained replication-competent HIV-1; 41 (85%) of 48 simultaneously obtained peripheral blood mononuclear cell samples contained replication-competent HIV-1. None of 26 urine samples available for analysis contained HIV-1 p24 antigen as determined by ELISA; 12 (34%) of 35 simultaneously obtained peripheral blood samples had detectable serum HIV-1 p24 antigen. Two of the individuals studied had HIV nephropathy, three had pyuria, and five had microscopic hematuria. Culture sensitivity was maximal when mycostatin (and not amphotericin B) was used as an antifungal agent. Our findings indicate that urine from HIV-1-seropositive individuals is unlikely to contain infectious HIV-1. This would imply that the risk of transmission of HIV-1 by urine is low to nonexistent.
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PMID:Absence of infectious HIV-1 in the urine of seropositive viremic subjects. 251 Dec 53

The number of intravenous drugs users (IVDUs) developing end-stage renal disease at our institution increased 400% between 1981 and 1987. During this period the total number of IVDUs in our catchment area remained stable and referral patterns to our hospital were unchanged. A serologic, clinical and risk-factor survey for HIV infection was conducted in our maintenance hemodialysis unit with the objective of evaluating the interrelationship between HIV infection and the increasing incidence of renal failure in IVDUs. The risk of nosocomial transmission of HIV in a hemodialysis unit with an expected high prevalence of infection was also investigated. The effect of HIV seropositivity on the clinical course of patients receiving maintenance hemodialysis was evaluated prospectively. Twenty-seven (39%) out of 70 maintenance hemodialysis patients tested were seropositive for HIV. Twenty-three (88%) out of 26 IVDUs receiving dialysis were seropositive for HIV. Despite marked CD4 cell depletion (mean CD4 cell count 225), none of the seropositive patients had AIDS when first evaluated and only one developed AIDS during 12 months of follow-up. None of the dialysis staff members or dialysis patients without HIV risk factors was seropositive for HIV. IVDUs who develop end-stage renal disease appear to have a high rate of infection with HIV. We can expect that the number of HIV-infected dialysis patients will continue to increase. Fortunately, even in a high prevalence hemodialysis unit, the risk of nosocomial transmission of HIV appears to be low.
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PMID:HIV infection in a high prevalence hemodialysis unit. 251 79


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