2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Immune Complex Renal Disease

• Not all renal disease in HIV is HIVAN • In a multicenter observational study of 89 HIV patients with a renal bx, 50% had a disease other than HIVAN • Non-HIVAN patients: better renal outcome, Caucasian, higher CD4, more often co- infected with HCV

Szczech et al. KI 2004

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Obstruction Intrarenal: • Due to drug precipitation out of the urine and formation of crystals in the tubules • Associated with: Sulfadiazine, acyclovir, indinavir, foscarnet, atazanavir • Risk factors: volume depletion, hypoalbuminemia and CKD Extrarenal : • Atazanavir nephrolithiasis • Retroperitoneal fibrosis • Pelvic lymphadenopathy - Lymphoma, histoplasmosis, MAC • Fungus balls - Candida, aspergillus

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Indinavir Crystals

Atta et al. Seminars 2008

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