What exactly is HIVAN?
HIVAN is a unique glomerular disease that is a result of the effects of active HIV viral replication within kidney tissue.
This is in direct contrast to HIVICK, which represents an immune complex medicated injury to the kidney. It is characterized by four pathologic changes in the kidney:
1. Collapsing variant of focal sclerosis: hypertrophy and hyperplasia of the podocytes to the point that it “caves in” the capillary tuft and reduces the filtration area of the glomerulus
2. Microcystic dilation of the tubules: markedly enlarged dilated tubules in the absence of obstruction
3. Interstitial nephritis: infiltration of the interstitial space of the kidney with CD8 + T cells
4. Tubulo-reticular inclusion bodies: the presence of arrays of coagulated proteins in the endoplasmic reticulum in proximal renal tubular cells that result from high levels of cytokines, such as γ-interferon. This is not pathognomonic of HIV and can be seen in systemic lupus erythematosis (SLE).
