To describe renal and HIV outcomes during immunosuppressive treatment for biopsy-confirmed lupus nephritis in a patient with HIV.
Approach:
Case: Researchers reported a 50-year-old woman with well-controlled HIV and biopsy-confirmed class III lupus nephritis.
Treatment and monitoring: She received corticosteroids, mycophenolate mofetil, and hydroxychloroquine while continuing antiretroviral therapy. Renal measures, lupus-related laboratory findings, CD4 count, and HIV viral load were monitored.
Key Findings:
By day 120, urinary protein excretion fell from 1,600 to 230 mg/day and the urine protein-to-creatinine ratio from 1.8 to 0.3; serum creatinine remained 0.6 mg/dL.
Complete renal remission was reported by 6 months, with preserved renal function. Anti-dsDNA levels decreased and complement concentrations normalized.
HIV control remained stable: at day 120, CD4 count was 580 cells/mm³ versus 600 at baseline, and viral load was 130 versus 120 copies/mL.
The report described sustained renal remission without lupus flares or opportunistic infections during the subsequent follow-up.
Interpretation:
The authors reported remission with immunosuppressive treatment in this patient, whose HIV was virologically controlled and whose CD4 count was preserved. They noted that serological and histopathological findings helped distinguish lupus nephritis from HIV-associated renal disease.
Limitations:
Single-patient report; findings cannot be generalized or used for statistical inference.
Disease activity was assessed with serial laboratory and renal measures rather than a validated composite index.
No repeat renal biopsy was performed, and follow-up was relatively short.
The patient's preserved CD4 count and low viral load limit applicability to people with advanced immunodeficiency or uncontrolled HIV.
Conclusion:
The case report describes complete renal remission after immunosuppressive treatment while antiretroviral therapy continued and HIV control remained stable.
