Rapid Progression to End-Stage Renal Disease in a Young Caucasian Female Newly Diagnosed With HIV Despite a Normal CD4 Count and Viral Load: A Case Report

TL;DR

A young woman with newly diagnosed HIV rapidly developed kidney failure despite normal immune markers.

Contribution

Highlights a rare and rapid progression of HIV-associated kidney disease in a patient with normal CD4 and viral load.

Findings

Patient presented with HIV and acute kidney injury despite normal CD4 count and low viral load.

Renal biopsy confirmed HIV-associated nephropathy with collapsing glomerulopathy and IgA deposits.

Disease progressed to end-stage renal disease requiring hemodialysis shortly after diagnosis.

Abstract

This is a case of a 31-year-old Caucasian female with a new diagnosis of human immunodeficiency virus (HIV) infection. At the time of diagnosis, her helper T cell (CD4 cell) count was within normal limits, and the viral load was low (356 copies/mL). She initially presented with uncontrolled hypertension and acute kidney injury (AKI) on a background of known chronic kidney disease stage IV (CKD-IV). Renal biopsy during admission revealed collapsing glomerulopathy with IgA deposits, findings consistent with HIV-associated nephropathy (HIVAN). Her disease course progressed quickly to end-stage renal disease (ESRD), requiring initiation of hemodialysis shortly after diagnosis.

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