Human Immunodeficiency Virus (HIV)/Hepatitis B Virus (HBV) Coinfection and Diffuse Interstitial Lymphocytosis Presenting With Kidney Disease

This case report highlights a rare presentation of acute kidney injury (AKI) with nephrotic syndrome in a Pacific Islander with concomitant acute HIV and hepatitis B virus (HBV) coinfection, progressing to require hemodialysis; the patient recovered completely and discontinued dialysis after a course of high-dose steroids and initiation of antiviral agents. The renal biopsy revealed features consistent with HIV-associated nephropathy (HIVAN) and HBV-associated nephropathy (HBVAN), along with diffuse interstitial lymphocytosis (DIL) showing dominant CD8 lymphocyte infiltration and high Hep B and HIV viral loads. Management challenges included the decision on the initiation of antiviral agents simultaneously with immunosuppressive agents. DIL syndrome (DILS) has become exceedingly rare since the advent of highly active antiretroviral therapy (HAART). To our knowledge, this is the first reported case of combined nephropathy in HIV-HBV coinfection.