1
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Sahragard I, Yaghobi R, Mohammadi A, Afshari A, Pakfetrat M, Hossein Karimi M, Reza Pourkarim M. Impact of BK Polyomavirus NCCR variations in post kidney transplant outcomes. Gene 2024; 913:148376. [PMID: 38490510 DOI: 10.1016/j.gene.2024.148376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
The human BK Polyomavirus (BKPyV) is a DNA virus that is prevalent in 80 % of the population. Infection with this virus may begin in childhood, followed by asymptomatic persistence in the urinary tract. However, in immunocompromised individuals, especially kidney transplant recipients (KTRs), heightened replication of BKPyV can lead to severe complications. The genome of this virus is divided into three parts; the early and late region, and the non-coding control region (NCCR). Mutations in the NCCR can change the archetype strain to the rearranged strain, and NCCR rearrangements play a significant in virus pathogenesis. Interestingly, diverse types of NCCR block rearrangement result in significant differences in conversion potential and host cell viability in the infected cells. A correlation has been detected between increased viral replication potential and pathogenesis in BKPyV-infected KTRs with specific NCCR rearrangements. The objective of this review study was to examine the disease-causing and clinical consequences of variations in the NCCR in BKPyV-infected KTRs such as virus-associated nephropathy (BKPyVAN).
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Affiliation(s)
- Ilnaz Sahragard
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Ramin Yaghobi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Mohammadi
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Afsoon Afshari
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Pakfetrat
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahmoud Reza Pourkarim
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute for Medical Research, Laboratory for Clinical and Epidemiological Virology, Herestraat 49 BE-3000, Leuven, Belgium
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2
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Ebrahimi N, Al Baghdadi M, Zuppan CW, Rogstad DK, Abdipour A. AIDS-Associated BK Virus Nephropathy in Native Kidneys: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2024; 12:23247096241232202. [PMID: 38375628 PMCID: PMC10880537 DOI: 10.1177/23247096241232202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/21/2024] Open
Abstract
BK virus (BKV) is a small DNA virus, a member of the polyomavirus family, that causes an opportunistic infection in immunocompromised patients, especially kidney transplant patients. This virus establishes a lifelong infection in most of the population, and once it reactivates in an immunocompromised state, leads to BKV nephropathy. This review seeks to assess the correlation between severe immunosuppression, evident by low CD4 cell counts in HIV-positive patients, and the reactivation of BKV, causing nephropathy. A literature review was conducted, extracting, and analyzing case reports of HIV-positive patients showing correlations between their degree of immunosuppression, as evidenced by their CD4 counts, and the degree of BKV infectivity, confirmed by kidney biopsy. A total of 12 cases of BKV nephropathy in HIV-infected patients were reviewed. A common finding was the presence of profound immunosuppression, with most patients having CD4 counts ≤50 cells/ mm3. A substantial number also had comorbid malignancies, with some undergoing chemotherapy, potentially increasing the risk of BKV reactivation. In addition to the HIV status and malignancies, other risk factors for BKV reactivation included older age, male gender, diabetes mellitus, Caucasian race, and ureteral stent placement. BKV nephropathy in HIV patients with native kidneys is closely correlated with severe immunosuppression. Although therapeutic strategies exist for post-transplant patients, aside from the treatment of HIV with highly active anti-retroviral therapy (HAART), which potentially helps with clearing BKV by increasing CD4 count, there is no definitive treatment for a native kidney BKV nephropathy in patients with AIDS. The complexity of the cases and severity of comorbidities indicate the need for further research to develop therapeutic strategies tailored to this population.
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3
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Kruzel-Davila E, Sankofi BM, Kubi Amos-Abanyie E, Ghansah A, Nyarko A, Agyemang S, Awandare GA, Szwarcwort-Cohen M, Reiner-Benaim A, Hijazi B, Ulasi I, Raji YR, Boima V, Osafo C, May Adabayeri V, Matekole M, Olanrewaju TO, Ajayi S, Mamven M, Antwi S, Ademola AD, Plange-Rhule J, Arogundade F, Akyaw PA, Winkler CA, Salako BL, Ojo A, Skorecki K, Adu D. HIV Viremia Is Associated With APOL1 Variants and Reduced JC-Viruria. Front Med (Lausanne) 2021; 8:718300. [PMID: 34513880 PMCID: PMC8429812 DOI: 10.3389/fmed.2021.718300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Variants in the Apolipoprotein L1 (APOL1) gene (G1-rs60910145, rs73885319, G2-rs71785313) are common in Africans and in individuals of recent African ancestry and are associated with an increased risk of non-diabetic chronic kidney disease (CKD) and in particular of HIV associated nephropathy (HIVAN). In light of the significantly increased risk of HIVAN in carriers of two APOL1 risk alleles, a role in HIV infectivity has been postulated in the mechanism of APOL1 associated kidney disease. Herein, we aim to explore the association between HIV viremia and APOL1 genotype. In addition, we investigated interaction between BK and JC viruria, CKD and HIV viremia. A total of 199 persons living with HIV/AIDS (comprising 82 CKD cases and 117 controls) from among the participants in the ongoing Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network case control study have been recruited. The two APOL1 renal risk alleles (RRA) genotypes were associated with a higher risk of CKD (OR 12.6, 95% CI 3.89-40.8, p < 0.0001). Even a single APOL1 RRA was associated with CKD risk (OR 4.42, 95% CI 1.49-13.15, p = 0.007). The 2 APOL1 RRA genotypes were associated with an increased probability of having HIV viremia (OR 2.37 95% CI 1.0-5.63, p = 0.05). HIV viremia was associated with increased CKD risk (OR 7.45, 95% CI 1.66-33.35, P = 0.009) and with a significant reduction of JC virus urine shedding (OR 0.35, 95% CI 0.12-0.98, p = 0.046). In contrast to prior studies, JC viruria was not associated with CKD but was restricted in patients with HIV viremia, regardless of CKD status. These findings suggest a role of APOL1 variants in HIV infectivity and emphasize that JC viruria can serve as biomarker for innate immune system activation.
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Affiliation(s)
- Etty Kruzel-Davila
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Nephrology Department, Rambam Health Care Campus, Haifa, Israel
| | - Barbara Mensah Sankofi
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Ernestine Kubi Amos-Abanyie
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Anita Ghansah
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Alexander Nyarko
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Seth Agyemang
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Gordon A. Awandare
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | | | | | - Basem Hijazi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ifeoma Ulasi
- Department of Medicine, College of Health Sciences University of Nigeria, Enugu, Nigeria
| | | | - Vincent Boima
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Charlotte Osafo
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Victoria May Adabayeri
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Michael Matekole
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Timothy O. Olanrewaju
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Ajayi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Manmak Mamven
- Department of Medicine, University of Abuja, Abuja, Nigeria
| | - Sampson Antwi
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Jacob Plange-Rhule
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Priscilla Abena Akyaw
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Cheryl A. Winkler
- Department of Medicine, Frederick National Laboratory for Cancer Research (NIH), Frederick, MD, United States
| | | | - Akinlolu Ojo
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Karl Skorecki
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Rambam Health Care Campus, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Dwomoa Adu
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Hodel F, Chong AY, Scepanovic P, Xu ZM, Naret O, Thorball CW, Rüeger S, Marques-Vidal P, Vollenweider P, Begemann M, Ehrenreich H, Brenner N, Bender N, Waterboer T, Mentzer AJ, Hill AVS, Hammer C, Fellay J. Human genomics of the humoral immune response against polyomaviruses. Virus Evol 2021; 7:veab058. [PMID: 34532061 PMCID: PMC8438875 DOI: 10.1093/ve/veab058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022] Open
Abstract
Human polyomaviruses are widespread in humans and can cause severe disease in immunocompromised individuals. To identify human genetic determinants of the humoral immune response against polyomaviruses, we performed genome-wide association studies and meta-analyses of qualitative and quantitative immunoglobulin G responses against BK polyomavirus (BKPyV), JC polyomavirus (JCPyV), Merkel cellpolyomavirus (MCPyV), WU polyomavirus (WUPyV), and human polyomavirus 6 (HPyV6) in 15,660 individuals of European ancestry from three independent studies. We observed significant associations for all tested viruses: JCPyV, HPyV6, and MCPyV associated with human leukocyte antigen class II variation, BKPyV and JCPyV with variants in FUT2, responsible for secretor status, MCPyV with variants in STING1, involved in interferon induction, and WUPyV with a functional variant in MUC1, previously associated with risk for gastric cancer. These results provide insights into the genetic control of a family of very prevalent human viruses, highlighting genes and pathways that play a modulating role in human humoral immunity.
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Affiliation(s)
| | - A Y Chong
- The Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, United Kingdom
| | - P Scepanovic
- Roche Pharmaceutical Research and Early Development, F. Hoffmann-La Roche Ltd, Headquarters Grenzacherstrasse 124, CH-4070 Basel, Switzerland
| | - Z M Xu
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland,Swiss Institute of Bioinformatics, Quartier UNIL-Sorge, CH-1015 Lausanne, Switzerland
| | - O Naret
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland,Swiss Institute of Bioinformatics, Quartier UNIL-Sorge, CH-1015 Lausanne, Switzerland
| | - C W Thorball
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - S Rüeger
- Institute for Molecular Medicine Finland, Institute of Life Science HiLIFE, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - P Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | | | - M Begemann
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, DFG Research Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Hermann-Rein-Straße 3, 37075 Göttingen, Germany
| | - H Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, DFG Research Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Hermann-Rein-Straße 3, 37075 Göttingen, Germany
| | - N Brenner
- Infections and Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - N Bender
- Infections and Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - T Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | | | - A V S Hill
- The Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, United Kingdom,The Jenner Institute, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Oxford OX1 2JD, United Kingdom
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5
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Tariq A, Kim H, Abbas H, Lucas GM, Atta MG. Pharmacotherapeutic options for kidney disease in HIV positive patients. Expert Opin Pharmacother 2020; 22:69-82. [PMID: 32955946 DOI: 10.1080/14656566.2020.1817383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Since the developmentof combined antiretroviral therapy (cART), HIV-associated mortality and the incidence of HIV-associated end-stage kidney disease (ESKD) has decreased. However, in the United States, an increase in non-HIV-associated kidney diseases within the HIV-positive population is expected. AREAS COVERED In this review, the authors highlight the risk factors for kidney disease within an HIV-positive population and provide the current recommendations for risk stratification and for the monitoring of its progression to chronic kidney disease (CKD), as well as, treatment. The article is based on literature searches using PubMed, Medline and SCOPUS. EXPERT OPINION The authors recommend clinicians (1) be aware of early cART initiation to prevent and treat HIV-associated kidney diseases, (2) be aware of cART side effects and discriminate those that may become more nephrotoxic than others and require dose-adjustment in the setting of eGFR ≤ 30ml/min/1.73m2, (3) follow KDIGO guidelines regarding screening and monitoring for CKD with a multidisciplinary team of health professionals, (4) manage other co-infections and comorbidities, (5) consider changing cART if drug induced toxicity is established with apparent eGFR decline of ≥ 10ml/min/1.73m2 or rising creatinine (≥0.5mg/dl) during drug-drug interactions, and (6) strongly consider kidney transplant in appropriately selected individuals with end stage kidney failure.
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Affiliation(s)
- Anam Tariq
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Hannah Kim
- Division of Pediatric Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Hashim Abbas
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Gregory M Lucas
- Division of Infectious Disease, Johns Hopkins University , Baltimore, MD, US
| | - Mohamed G Atta
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
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Shah A, Kumar V, Palmer MB, Trofe-Clark J, Laskin B, Sawinski D, Hogan JJ. Native kidney BK virus nephropathy, a systematic review. Transpl Infect Dis 2019; 21:e13083. [PMID: 30907978 DOI: 10.1111/tid.13083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is a growing base of literature describing BK nephropathy (BKVN) in patients outside of the setting of kidney transplant. Previous systematic reviews of the literature have been limited by methodology or by the scope of patients included. STUDY DESIGN AND METHODS Systematic Review (Prospero # CRD42018088524). SETTING & POPULATION Patients without kidney transplant who had biopsy-proven BKVN. SELECTION CRITERIA FOR STUDIES Full-text articles that describe native BKVN patient cases. ANALYTICAL APPROACH Descriptive synthesis. RESULTS The search identified 630 unique articles of which 51 were included in the final review. Sixty-five cases (including two new cases presented in this review) were identified, all but one occurred in the setting of known immunosuppression. LIMITATIONS The primary limitation was the exclusion of studies that did not fulfill the stringent review criteria. We excluded reports with only a clinical diagnosis of BKVN, such as those with viruria and/or viremia without biopsy. CONCLUSIONS As of May 2018, there are 65 reported cases of BKVN in native kidneys. This represents the most comprehensive description of biopsy-proven BKVN in native kidneys to date. Evaluation for BK nephropathy should be considered in immunocompromised patients who exhibit unexplained renal failure.
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Affiliation(s)
- Ankur Shah
- Division of Nephrology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinayak Kumar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew B Palmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Trofe-Clark
- Division of Nephrology, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pharmacy Services, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Laskin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Nephrology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deirdre Sawinski
- Division of Nephrology, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan J Hogan
- Division of Nephrology, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Barthélemy A, Bouvier N, Verdon R, Chatelet V, Hurault de Ligny B. Successful renal retransplantation after graft loss from BK polyomavirus infection in a human immunodeficiency virus-positive patient. Transpl Infect Dis 2016; 18:946-949. [PMID: 27717279 DOI: 10.1111/tid.12615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 12/13/2022]
Abstract
We report the case of a human immunodeficiency virus-seropositive patient whose initial kidney transplant failed because of BK polyomavirus-induced nephropathy, and who underwent a second transplantation 3 years later. BK viruria was detected 1 day after transplantation. After 1 month, BK viremia developed along with a donor-specific antibody. After decreasing tacrolimus and mycophenolic acid and 2 courses of intravenous immunoglobulins, BK viremia and donor-specific antibody permanently disappeared, with stable renal function.
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Affiliation(s)
- Aurore Barthélemy
- Department of Nephrology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, Caen, France
| | - Nicolas Bouvier
- Department of Nephrology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, Caen, France
| | - Renaud Verdon
- Medical School, Université Caen Normandie, Caen, France.,Infectious Diseases Unit, CHU de Caen, Caen, France
| | - Valérie Chatelet
- Department of Nephrology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, Caen, France
| | - Bruno Hurault de Ligny
- Department of Nephrology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, Caen, France
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8
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Vigil D, Konstantinov NK, Barry M, Harford AM, Servilla KS, Kim YH, Sun Y, Ganta K, Tzamaloukas AH. BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection. World J Transplant 2016; 6:472-504. [PMID: 27683628 PMCID: PMC5036119 DOI: 10.5500/wjt.v6.i3.472] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 02/05/2023] Open
Abstract
Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy (BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.
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9
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Akhgari S, Mohraz M, Azadmanesh K, Vahabpour R, Kazemimanesh M, Aghakhani A, Jozpanahi M, Banifazl M, Bavand A, Ramezani A. Frequency and subtype of BK virus infection in Iranian patients infected with HIV. Med Microbiol Immunol 2015; 205:57-62. [PMID: 26141042 DOI: 10.1007/s00430-015-0426-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/25/2015] [Indexed: 12/23/2022]
Abstract
Human polyomavirus BK virus (BKV) is a double-stranded DNA virus that infects approximately 90 % of the general population as a subclinical or mild infection. In immunosuppressed patients, such as HIV cases, BKV may be reactivated resulting hemorrhagic cystitis and tubulointerstitial nephritis. However, there are limited studies on prevalence and molecular epidemiology of BKV in Iran. We therefore aimed to evaluate the prevalence and subtypes of BKV in Iranian HIV patients. A total of 99 patients with HIV infection were enrolled in the study. Presence of BKV DNA in plasma was evaluated by nested PCR. PCR products were sequenced directly, and phylogenetic analysis was performed. BKV DNA was detected in 8.08 % of HIV patients. BKV viremia presented in 4 out of 25 patients (16 %) not receiving antiretroviral therapy in comparison with 4 out 74 of HAART-treated patients (5.4 %) (P = 0.023). In patients with CD4 counts ≥200 cells/mm(3), viremia was found more commonly (7/80 = 8.8 %) than in those with lower counts (1/19 = 5.2 %) (not significant). All sequenced BKV isolates belonged to subtype Ib-2. Our findings indicated that the prevalence of BKV viremia is relatively prevalent in patients with HIV infection and significantly higher in naïve than HAART-treated cases. Therefore, HAART can eliminate BKV infection from plasma and reduce viremia although the actual implication of BKV viremia in HIV patients is not clear.
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Affiliation(s)
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Tehran, Iran.
| | | | | | | | - Arezoo Aghakhani
- Clinical Research Department, Pasteur Institute of Iran, 13164, Pasteur Ave., Tehran, Iran.
| | | | - Mohammad Banifazl
- Iranian Society for Support of Patients with Infectious Disease, Tehran, Iran.
| | - Anahita Bavand
- Clinical Research Department, Pasteur Institute of Iran, 13164, Pasteur Ave., Tehran, Iran.
| | - Amitis Ramezani
- Clinical Research Department, Pasteur Institute of Iran, 13164, Pasteur Ave., Tehran, Iran.
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10
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Melica G, Matignon M, Desvaux D, Audard V, Copie-Bergman C, Lang P, Levy Y, Grimbert P. Acute Interstitial Nephritis With Predominant Plasmacytic Infiltration in Patients With HIV-1 Infection. Am J Kidney Dis 2012; 59:711-4. [DOI: 10.1053/j.ajkd.2011.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 12/13/2011] [Indexed: 11/11/2022]
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11
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Ledesma J, Muñoz P, Garcia de Viedma D, Cabrero I, Loeches B, Montilla P, Gijon P, Rodriguez-Sanchez B, Bouza E. BK virus infection in human immunodeficiency virus-infected patients. Eur J Clin Microbiol Infect Dis 2011; 31:1531-5. [PMID: 22086655 DOI: 10.1007/s10096-011-1474-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 10/20/2011] [Indexed: 12/16/2022]
Abstract
The aim of this study is to evaluate the prevalence of BK virus (BKV) infection in HIV-positive patients receiving highly active antiretroviral therapy (HAART) in our hospital. The presence of BKV was analysed in urine and plasma samples from 78 non-selected HIV-infected patients. Clinical data were recorded using a pre-established protocol. We used a nested PCR to amplify a specific region of the BKV T-large antigen. Positive samples were quantified using real-time PCR. Mean CD4 count in HIV-infected patients was 472 cells/mm3 and median HIV viral load was <50 copies/mL. BKV viraemia was detected in only 1 HIV-positive patient, but 57.7% (45 out of 78) had BKV viruria, which was more common in patients with CD4 counts>500 cells/mm3 (74.3% vs 25.7%; p=0.007). Viruria was present in 21.7% of healthy controls (5 out of 23 samples, p=0.02). All viral loads were low (<100 copies/mL), and we could not find any association between BKV infection and renal or neurological manifestations. We provide an update on the prevalence of BKV in HIV-infected patients treated with HAART. BKV viruria was more common in HIV-infected patients; however, no role for BKV has been demonstrated in this population.
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Affiliation(s)
- J Ledesma
- Department of Clinical Microbiology-Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
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Adih WK, Selik RM, Hu X. Trends in Diseases Reported on US Death Certificates That Mentioned HIV Infection, 1996-2006. ACTA ACUST UNITED AC 2010; 10:5-11. [PMID: 21088284 DOI: 10.1177/1545109710384505] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We examined trends during 1996-2006 in diseases reported on death certificates that mentioned HIV infection. METHODS We analyzed multiple-cause mortality data compiled from all US death certificates with any mention of HIV to determine the annual percentages of deaths with various diseases. RESULTS Deaths reported with HIV during 1996-2006 decreased from 35 340 to 13 750. Standardized percentages of death certificates reporting AIDS-defining opportunistic infections also decreased: pneumocytosis (6.3% to 5.1%), nontuberculous mycobacteriosis (5.5% to 1.8%), cytomegalovirus (5.7% to 1.2%). Non-Hodgkin's lymphoma rose from 4.8% in 1996 to 6.4% in 1997 and declined to 5.0% in 2001, while Kaposi's sarcoma declined from 3.7% in 1996 to 1.7% in 2001; these AIDS-defining cancers had stable percentages after 2001. All other cancers increased during 1996-2006 (2.7% to 7.3%). The percentage of deaths with diseases not specifically attributable to HIV increased: liver disease (5.8% to 13.0%), kidney disease (7.9% to 12.0%), and heart disease (4.9% to 10.2%). CONCLUSION Among deaths reported with HIV, the percentages reported with HIV-attributable diseases decreased, while the percentages reported with other diseases increased. Consequently, these other life-threatening diseases need more attention in the management of HIV-infected persons.
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Affiliation(s)
- William K Adih
- Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia,
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BK virus-associated nephropathy in an HIV-positive patient with gingival plasmablastic lymphoma. Int J Hematol 2010; 92:208-10. [PMID: 20577836 DOI: 10.1007/s12185-010-0629-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 05/29/2010] [Accepted: 06/06/2010] [Indexed: 12/16/2022]
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Parkhie SM, Fine DM, Lucas GM, Atta MG. Characteristics of patients with HIV and biopsy-proven acute interstitial nephritis. Clin J Am Soc Nephrol 2010; 5:798-804. [PMID: 20338962 DOI: 10.2215/cjn.08211109] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to describe the characteristics of patients with HIV infection and biopsy-proven acute interstitial nephritis (AIN). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Pathology reports were reviewed for patients who had HIV infection and underwent renal biopsy at Johns Hopkins Hospital from January 1, 1995, through January 1, 2008. Patients who received a diagnosis of AIN without evidence of HIV-associated nephropathy were identified, and their clinical course was reviewed up to 18 months after biopsy. RESULTS Of 262 biopsies, 29 (11%) patients who had AIN without evidence of HIV-associated nephropathy were identified. The mean age at the time of biopsy was 47.5 years (range 28 to 71 years), 17 (59%) were men, and 23 (79%) were black. The majority (62%) of patients were on antiretroviral therapy, 59% were current or former intravenous drug users, and 62% had hepatitis C co-infection. Drugs were identified as the cause of AIN in the majority (72%) of cases. Nonsteroidal anti-inflammatory drugs were most commonly implicated, followed by sulfamethoxazole/trimethoprim. Antiretroviral therapy was identified as the cause in only three cases. None of the patients presented with the classic triad of fever, rash, and pyuria, and only seven (24%) patients presented with <1 g/d proteinuria. CONCLUSIONS In our series, AIN was prevalent (11%) and was often drug induced. AIN should not be excluded from the differential diagnosis on the basis of absence of the classic clinical triad of fever, rash, and pyuria.
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Affiliation(s)
- Shyam M Parkhie
- Division of Renal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Núñez M, Saran AM, Freedman BI. Gene-gene and gene-environment interactions in HIV-associated nephropathy: A focus on the MYH9 nephropathy susceptibility gene. Adv Chronic Kidney Dis 2010; 17:44-51. [PMID: 20005488 DOI: 10.1053/j.ackd.2009.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 07/29/2009] [Accepted: 08/10/2009] [Indexed: 11/11/2022]
Abstract
HIV-associated nephropathy (HIVAN) is a leading cause of ESRD in African Americans. The HIV-1 virus infects podocytes, cells integral to formation of the glomerular filtration barrier, often leading to focal segmental glomerulosclerosis. HIVAN is typically a complication of late-stage HIV infection, associated with low CD4 cell counts and elevated serum HIV RNA levels. Highly active antiretroviral therapy is partially protective and has altered the natural history of HIV-associated kidney disease. Nonetheless, HIVAN remains an important public health concern among HIV-infected African Americans. Although polymorphisms in the MYH9 gene on chromosome 22 are strongly associated with HIVAN, as well as with idiopathic focal segmental glomerulosclerosis and global glomerulosclerosis (historically labeled "hypertensive nephrosclerosis"), the majority of HIV-infected patients who are genetically at risk from MYH9 do not appear to develop severe kidney disease. Therefore, we postulate that additional environmental exposures and/or inherited factors are necessary to initiate human HIVAN. Gene-environment interactions have also been proposed as necessary for the initiation of HIVAN in murine models. It is important that these novel risk factors be identified because prevention of environmental exposures and targeting of additional gene products may reduce the risk for HIVAN, even among those harboring 2 risk alleles in MYH9.
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Nukuzuma S, Kameoka M, Sugiura S, Nakamichi K, Nukuzuma C, Miyoshi I, Takegami T. Archetype JC virus efficiently propagates in kidney-derived cells stably expressing HIV-1 Tat. Microbiol Immunol 2009; 53:621-8. [PMID: 19903262 DOI: 10.1111/j.1348-0421.2009.00166.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pathogenic JCV with rearranged regulatory regions (PML-type) causes PML, a demyelinating disease, in the brains of immunocompromised patients. On the other hand, archetype JCV persistently infecting the kidney is thought to be converted to PML-type virus during JCV replication in the infected host under immunosuppressed conditions. In addition, Tat protein, encoded by HIV-1, markedly enhances the expression of a reporter gene under control of the JCV late promoter. In order to examine the influence of Tat on JCV propagation, we used kidney-derived COS-7 cells, which only permit archetype JCV, and established COS-tat cells, which express HIV-1 Tat stably. We found that the extent of archetype JCV propagation in COS-tat cells is significantly greater than in COS-7 cells. On the other hand, COS-7 cells express SV40 T antigen, which is a strong stimulator of archetype JCV replication. The expression of SV40 T antigen was enhanced by HIV-1 Tat slightly according to real-time RT-PCR, this was not closely related to JCV replication in COS-tat cells. The efficiency of JCV propagation depended on the extent of expression of functional Tat. To our knowledge, this is the first report of increased production of archetype JCV in a culture system using cell lines stably expressing HIV-1 Tat. We propose here that COS-tat cells are a useful tool for studying the role of Tat in archetype JCV replication in the development of PML.
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Affiliation(s)
- Souichi Nukuzuma
- Department of Microbiology, Kobe Institute of Health, 4-6, Minatojima-Nakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan.
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Abstract
Polyomaviruses are a growing family of small DNA viruses with a narrow tropism for both the host species and the cell type in which they productively replicate. Species host range may be constrained by requirements for precise molecular interactions between the viral T antigen, host replication proteins, including DNA polymerase, and the viral origin of replication, which are required for viral DNA replication. Cell type specificity involves, at least in part, transcription factors that are necessary for viral gene expression and restricted in their tissue distribution. In the case of the human polyomaviruses, BK virus (BKV) replication occurs in the tubular epithelial cells of the kidney, causing nephropathy in kidney allograft recipients, while JC virus (JCV) replication occurs in the glial cells of the central nervous system, where it causes progressive multifocal leukoencephalopathy. Three new human polyomaviruses have recently been discovered: MCV was found in Merkel cell carcinoma samples, while Karolinska Institute Virus and Washington University Virus were isolated from the respiratory tract. We discuss control mechanisms for gene expression in primate polyomaviruses, including simian vacuolating virus 40, BKV, and JCV. These mechanisms include not only modulation of promoter activities by transcription factor binding but also enhancer rearrangements, restriction of DNA methylation, alternate early mRNA splicing, cis-acting elements in the late mRNA leader sequence, and the production of viral microRNA.
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Abstract
PURPOSE OF REVIEW To present an overview of the epidemiology and etiology of acute kidney injury (AKI) in patients infected with human immunodeficiency virus (HIV). RECENT FINDINGS HIV-infected patients are at an increased risk of developing AKI. Potential risk factors for the development of AKI in this patient population include increased HIV viral loads, reduced CD4 cell counts, hepatitis C virus coinfection, a history of diabetes, black race, male gender, and baseline chronic kidney and hepatic disease. Observational studies have found an increased morbidity and mortality in HIV-infected patients who develop AKI. There are diverse etiologies of AKI in HIV-infected patients, with increasing reports of highly active antiretroviral therapy-related nephropathy secondary to tenofovir nephrotoxicity. There have also been recent case reports of HIV-infected patients who develop a unique form of acute interstitial nephritis secondary to diffuse infiltrative lymphocytosis syndrome. SUMMARY There are a variety of etiologies of AKI in HIV-infected patients. Prompt diagnosis and treatment of AKI is critical to help prevent morbidity and mortality in this patient population.
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Abstract
SUMMARY Human immunodeficiency virus (HIV)-infected patients may acquire new viral co-infections; they also may experience the reactivation or worsening of existing viral infections, including active, smoldering, or latent infections. HIV-infected patients may be predisposed to these viral infections owing to immunodeficiency or risk factors common to HIV and other viruses. A number of these affect the kidney, either by direct infection or by deposition of immune complexes. In this review we discuss the renal manifestations and treatment of hepatitis C virus, BK virus, adenovirus, cytomegalovirus, and parvovirus B19 in patients with HIV disease. We also discuss an approach to the identification of new viral renal pathogens, using a viral gene chip to identify viral DNA or RNA.
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Affiliation(s)
- Meryl Waldman
- Kidney Disease Section, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-1268, USA.
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