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Late onset of HIVAN in a young female - a case report.

INTRODUCTION
Human Immunodeficiency Virus associated Nephropathy (HIVAN) is a relatively frequent pathology among HIV patients, especially in black patients. Among about 800 HIV-infected patients from the Western Romania cohort, mainly of subtype F, none were diagnosed documented with renal biopsy with HIV-associated nephropathy. Renal alterations etiology seems to be complex. Several renal abnormalities have been described among HIV-infected patients. Patient, Methods and Results: We discuss the case of a 24-year-old white Caucasian female HIV-infected in 1990 by horizontal transmission, in her first year of life. She was diagnosed as late-presenter stage C3 at the age of 10, when she was admitted in coma secondary to toxoplasmic encephalitis. The clinical evolution was favorable under antiretroviral treatment until 2003 when dyslipidemia and arterial hypertension appeared. The first clinical manifestations of nephropathy were detected in 2006, with altered values of creatinine clearance. A 7-year follow-up of renal impairment shows a descending trend of creatinine clearance values. We analyzed the repeated ultrasound findings and renal biopsy was performed in 2013 revealing aspects of HIVAN. It has become obvious that HIVAN is caused by direct effects of HIV-1 virus over kidney structure and also that within the renal cells, viral replication is still permitted. In our case, the viral load peaked in 2011 at the same time the renal function significantly deteriorated. Her lifestyle changes must be taken under consideration - in the last year she has been under a low protein regimen. Compliance to antiretroviral treatment improves survival rate with a delayed deterioration of renal function to end-stage renal disease.


CONCLUSIONS
Renal biopsy remains the most important feature in order to diagnose HIVAN. Suspicion of HIVAN diagnosis should be taken under consideration in the presence of constant proteinuria as well as decreased creatinine clearance levels.