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

• Main Authors: K. Manakhov, E. Povysheva, A. Gilyazova, D. Sarksyan
• Format: Article
• Language: Russian
• Published: Sankt-Peterburg : NIIÈM imeni Pastera 2019-06-01
• Series: Infekciâ i Immunitet
• Subjects: hemorrhagic fever with renal syndrome; hiv infection; acute kidney injury; immune mediated damage; natural focal infections; chronic renal pathology
• Online Access: https://www.iimmun.ru/iimm/article/view/1395
• ISSN: 2220-7619; 2313-7398

Human immunodeficiency virus (HIV) is a significant medical and social problem for many developed countries. With HIV infection, the development of chronic kidney pathology is characteristic, as well as the development of acute renal damage. In a number of regions, hemorrhagic fever with renal syndrome (HFRS) can make a certain contribution to the development of renal pathology in HIV-infected people. The aim of the study is to identify the clinical and laboratory features of the course of HFRS against the background of HIV infection. A retrospective study was conducted. Two groups were formed: the first – 9 patients who had suffered from HFRS against the background of existing HIV infection; the second - 53 patients who had suffered from HFRS and did not have clinical and epidemiological indications for HIV infection. The compared groups are comparable by gender and age. The average age of the patients of the first group was 34 years, the second - 31. For statistical analysis, the licensed program SPSS 22.0 was used. The critical significance level p for statistical criteria was taken equal to 0.05. In general, in all patients, the course of HFRS was accompanied by characteristic manifestations: 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 are often concerned about dry mouth, bloating, visible shortness of breath. Lab changes describe more severe kidney damage. A direct strong relationship was shown between the number of leukocytes and the level of urea in the blood in patients with concomitant HIV infection (r = 0.798; p = 0.01). The combination of HFRS and HIV was accompanied by a milder course of HFRS - the incidence of mild disease is almost 6 times higher among this group of patients. In this case, there were no cases of severe hemorrhagic fever with renal syndrome when combined with HIV. In the course of this study, mixed results were obtained. The predisposition of HIV-infected patients to renal pathology can be a determining factor in kidney damage in the event of HFRS: a more pronounced increase in creatinine and urea. Moreover, in accordance with a rating scale for assessing the severity of HFRS, it formally turned out that with concomitant HIV infection, patients more often correspond to a mild severity of the disease, 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 in the progression of chronic renal pathology and a predictor of death. Consequently, this patient population needs close monitoring both at the inpatient and outpatient stages.