Complete remission of HIV-associated glomerular disease with tacrolimus, followed by late-onset Kaposi sarcoma: A report of two cases

BACKGROUND: Glomerular disease in people living with HIV (PLWH) may require immunosuppressive therapy to control sever proteinuria. However, the long-term safety of calcineurin inhibitors in this population remains uncertain. CASE PRESENTATION/METHODS: We report two cases of HIV-positive individuals with sustained virological suppression on antiretroviral therapy who developed nephrotic-range glomerular disease with massive proteinuria. Both patients were treated with tacrolimus to control proteinuria. RESULTS: Treatment with tacrolimus led to complete and sustained remission of proteinuria for more than five years in both cases. Subsequently, both patients developed Kaposi sarcoma. CONCLUSIONS: These cases raise concerns regarding the prolonged use of calcineurin inhibitors in PLWH with glomerular diseases, as long-term immunosuppression may impair oncogenic immune surveillance and promote reactivación of latent viruses such as human herpesvirus-8. Our findings underscore the need for caution when considering extended immunosuppressive therapy in this population, particularly given the limited available treatment options. To our knowledge, this clinical course has not been previously reported.