Features of the course of hemorrhagic fever with renal syndrome in HIV-infected patients

Abstract

Human immunodeficiency virus (HIV) is a significant medical and social problem for many developed countries. HIV infection is featured with developing chronic kidney pathology as well as acute renal damage. In some regions, hemorrhagic fever with renal syndrome (HFRS) can contribute somehow to developing renal pathology in HIVinfected subjects. The aim of the study was to identify clinical and laboratory features of HFRS course during HIV infection. A retrospective study was conducted by forming two groups: group 1 consisted of 9 patients suffered from HFRS together with verified HIV infection, group 2 — 53 patients with HFRS but lacking any clinical and epidemiological indications supporting HIV infection. Subjects in both groups were age- and sex-matched. The average age of the patients in group 1 and group 2 was 34 and 31 years, respectively. For statistical analysis, the licensed SPSS 22.0 software was used. A significance level p for statistical criteria was set equal to 0.05. In general, HFRS course in all patients was accompanied by characteristic signs: intoxication syndrome, impaired vision, hemorrhagic rash, pain in the lumbar region, decreased diuresis, thrombocytopenia, proteinuria, polymorphic urinary syndrome and azotemia. HFRS patients with concomitant HIV infection often complain of dry mouth, bloating, visible shortness of breath. Laboratory changes describe more severe kidney damage. A direct strong correlation was shown between leukocyte count and level of blood urea in patients with concomitant HIV infection (r = 0.798; p = 0.01). The combination of HFRS and HIV was accompanied by a milder HFRS course — rate of mild disease was almost 6-fold higher among patients of this group. In this case, no cases of severe hemorrhagic fever with renal syndrome combined with HIV were noted. Our study allowed to obtain unambiguous data. Predisposition of HIV-infected patients to renal pathology may be a determining factor in kidney damage upon emerging HFRS: more prominent rise in creatinine and urea level. Moreover, according to rating scale for assessing HFRS severity, it formally turned out that during concomitant HIV infection patients more often fit to a mild disease severity, even in the presence of more pronounced renal manifestations. The occurrence of acute renal pathology in HIV-infected patients is a life-threatening condition, a factor of deterioration of chronic renal pathology and a predictor of death. Consequently, this patient population requires thorough monitoring both at inpatient and outpatient stages.

Keywords

• hemorrhagic fever with renal syndrome
• hiv infection
• acute kidney injury
• immune-mediated damage
• natural focal infections
• chronic renal pathology