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.