Breillat Paul, Pourcher Valérie, Deshayes Samuel, Buob David, Cez Alexandre, Michel Pierre-Antoine, Boffa Jean-Jacques, Langlois Vincent, Grateau Gilles, Georgin-Lavialle Sophie
Department of Internal Medicine, Sorbonne University, AP-HP, Tenon Hospital, Centre De Référence Des Maladies Auto-Inflammatoires Et Des Amyloses D'origine Inflammatoire (CEREMAIA), Paris, France.
Department of Infectious Diseases, Sorbonne University, APHP, Pitié Salpétrière Hospital, INSERM 1136, Paris, France.
Nephron. 2021;145(6):675-683. doi: 10.1159/000516982. Epub 2021 Jul 15.
HIV infection has been recently retained as an unclear cause of AA amyloidosis. Our aim was to investigate cases of AA amyloidosis associated with HIV infection to understand if it could be considered as a cause of AA amyloidosis.
A comprehensive literature review was conducted as well as retrospective study from French cases collected from our national reference center for AA amyloidosis.
Altogether, 19 patients with AA amyloidosis and HIV infection were found with 68% of men and median age at amyloidosis diagnosis of 38 years (range 28-75 years). Clinical presentation was nephrotic syndrome in 94% (n = 17/18). Among patients with renal involvement and assessable outcome (n = 17), 11 (64.7%) progressed to chronic kidney disease, with 6 (35%) end-stage renal disease. Seventy-five percent of patients had uncontrolled HIV infection and 71.4% CD4 counts <400/mm3 at amyloidosis diagnosis. Repeated or chronic bacterial or fungal infection was found in 47% of cases and a history of parenteral drug use in 55% of patients. Three patients had no classical or at least no suspected AA amyloidosis cause found or reported.
AA Amyloidosis is a rare condition in HIV patients with common renal involvement and significant risk of progression to chronic renal insufficiency. Because of the frequency related to other inflammatory conditions in this population, HIV is probably not an independent risk factor for AA amyloidosis.
