TreatmentUpdate 55 - Vol. 7, No. 1 - January 1995
Sean Hosein

In the early 1980s researchers found that some patients with HIV/AIDS had damaged kidneys. This complication even appeared in symptom-free patients. In the USA, HIV-infected patients from Miami and New York were more likely to have kidney dysfunction than patients from rural areas. In some patients the kidneys remove protein from the blood and dump it into the urine. Over the long term, this loss of protein and continued kidney damage may be dangerous. Researchers in Germany have been studying HIV- related kidney problems to try and find out why they happen. For their study the researchers recruited 90 subjects.

* STUDY DETAILS

All subjects were adults and had CD4+ cell counts greater than 500 cells. As well, all subjects received AZT 500 mg/day. Technicians performed ultrasound and other tests.

* RESULTS: DRUG USERS AND MEN WHO HAVE SEX WITH MEN

Looking at ultrasound scans, the researchers could not find any severe damage to the kidney. About 11 subjects had relatively high levels of protein in their urine. Gay/bisexual men and subjects with less than 200 CD4+ cells seemed more likely to have high levels of protein in their urine. Among the gay/bisexual men who had high levels of protein loss, 2 had CMV (cytomegalovirus) infection. When doctors gave these subjects the anti-CMV drug ganciclovir (DHPG, Cytovene(R)) protein loss dropped dramatically. Among drug users, high protein loss in the urine happened at CD4+ cell counts above 200 cells. One drug user had high blood levels of antibodies against the parasite that causes toxo (toxoplasmosis) Another drug user with a chronic chlamydia infection also had high levels of protein in his urine.

In this study the researchers divided the subjects into 4 groups based on how they became infected with HIV; hemophiliacs, heterosexual/transfusion recipients, gay/bisexual men and injection drug users. Some gay/bisexual men seemed more likely to have high levels of protein in their urine. This was still the case when the researchers looked at the other subjects with similar CD4+ cell counts. According to the researchers, there may be several reasons for protein loss and kidney damage:

- kidney malfunction - immune complexes being dumped in the kidney (irnmune complexes are a combination of an antibody joined to a protein, in this case, to HIV) - heroin toxicity - other infections

The researchers warn that patients with high levels of protein in their urine may be at risk for kidney damage from acyclovir (Zovirax) and certain antibiotics such as aminoglycosides (including gentamycin, neomycin and streptomycin).

REFERENCES:

1 . Busch HW, Riechrnann ST, Heyen P, et al. Albuminuria in HIV- infected patients. AIDS Researeh and Human Retrovuuses 1994;10(6):717-720.

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