Clinicopathological findings, correlations and outcomes in patients with renal disease and living with antiretroviral‐treated human immunodeficiency virus infection

Background and Aims

Antiretroviral therapy (ART) has modified the incidence of renal complications and the patterns of renal disease in people living with Human Immunodeficiency Virus (PLWH). We reviewed (2011–2021) the progress and outcomes (follow‐up to mid‐2025) of 158 such individuals.

Methods

Renal biopsies (59 subjects (BxGp)) were appraised, categorised and semi‐quantitated, and correlated with demographic, clinical and laboratory findings, and the progression of renal parameters was compared with 99 non‐biopsied subjects (NBxGp). Longer‐term outcomes (combined death and/or progression to end stage kidney disease (ESKD)) for both groups were assessed by regression.

Results

Proteinuria was the commonest presentation, and levels were higher ( P < 0.001) in BxGp subjects, especially those with glomerulonephritis, but did not correlate with semi‐quantitated acute or chronic histology scores. Conversely, estimated glomerular filtration (eGFR) levels did correlate with both acute ( r = −0.6397; P < 0.05) and chronic ( r = −0.4451; P < 0.01) histology scores, but overall rates of eGFR deterioration were not different between BxGp and NBxGp.

With cessation of tenofovir disoproxil fumarate (TDF), proteinuria specifically improved ( P < 0.01), and eGFR stabilised in BxGp subjects with acute tubular injury.

Proteinuria (but not eGFR) consistently predicted adverse longer‐term outcomes in unadjusted and Lasso regression models.

Conclusions

Renal biopsy is required for accurate diagnosis in ART‐treated PLWH developing renal disease. Proteinuria is a high‐priority prognostic marker in PLWH with renal disease but does not reliably predict underlying histopathology, and it was the only consistent risk factor predictor of longer‐term adverse outcomes of ESKD and/or death.