Different Sequential Renal Involvement in a Patient With HIV and Hepatitis C: From HIV‐ or Leishmaniasis‐Related Collapsing Glomerulosclerosis to Direct‐Acting Antivirals’ Renal Amyloidosis

The paradigm of renal involvement in HIV patients has changed in recent years, from HIV-associated nephropathy to nephroangiosclerosis, due to the increased survival of these patients and their comorbidities. Some of these are leishmaniasis and hepatitis C and their treatments, especially direct-acting antivirals, which may induce reconstitution of the cellular immunity and activate a latent autoinflammatory disease. Case presentation: We present a 51-year-old Caucasian patient with chronic HCV liver disease and HIV Stage A3 who suffered from kidney disease throughout his life. In the first episode, he debuted with nephrotic proteinuria when he was not taking any treatment for HIV. Renal biopsy showed focal segmental glomerulosclerosis that could be due to HIV or other infectious-related disease such as leishmaniasis. Whatever it is, the proteinuria responded to treatment for both infectious diseases. Nine years later, while the patient was on treatment with a new antiviral for HCV, he presented a complete nephrotic syndrome flare. A second biopsy showed amyloidosis A. The first biopsy was then reviewed, and minimal traces of amyloid were detected. Conclusions: Kidney involvement in HIV patients should be examined with high precision to detect any sign of different renal pathologies that may coexist. Comorbidities and their treatments might challenge and add to the differential diagnosis.