{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:34:22Z","timestamp":1787589262208,"version":"build-2736575974"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite widespread antiretroviral therapy (ART), kidney disease in people living with HIV remains clinically and biologically heterogeneous. Persistent immune imbalance\u2014reflected by CD4\/CD8 inversion\u2014often coexists with virologic suppression, yet its relevance within biopsy-defined renal phenotypes is incompletely understood. We aimed to characterize clinicopathological phenotypes and longitudinal renal trajectories in treated people living with HIV using the KDIGO histopathological framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective multicenter cohort study of PLWH undergoing native kidney biopsy in Mexico (2019\u20132025) with \u22656 months of follow-up. Biopsies were classified according to the KDIGO proposal. Renal trajectory was defined as &gt;25% decline (progression), \u226425% change (stabilization), or &gt;25% increase (improvement) in creatinine-based estimated glomerular filtration rate (eGFR). Immunologic parameters, histological chronicity indices, and kidney outcomes were analyzed descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Thirty-eight patients were included (87% men; median age 43 years). Late HIV diagnosis was frequent (47% with CD4+ &lt;200 cells\/\u00b5L). At biopsy, 92% were receiving ART; however, CD4\/CD8 inversion persisted in 84% at baseline and 76% at follow-up despite significant CD4+ recovery (p&lt;0.01). After a median follow-up of 15 [8-18] months, 24% developed kidney disease progression, whereas 76% showed stabilization or improvement. Baseline albuminuria was significantly higher among progressors (3,589 vs. 339 mg\/g; p=0.01), while CD4\/CD8 ratio was not associated with short-term progression. Immune complex disease presented earlier after HIV diagnosis and showed immunologic improvement (CD4+ p=0.01; CD4\/CD8 p&lt;0.01) with stable renal function. Podocytopathies exhibited greater structural chronicity, and tubulointerstitial disease was frequently associated with opportunistic infections, particularly disseminated mycobacterial disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In treated HIV infection, renal disease follows phenotype-specific trajectories in the context of persistent immune imbalance despite viral suppression. Albuminuria, rather than systemic immune indices, identified patients at higher short-term risk of progression. Biopsy-guided classification identified distinct clinicopathological phenotypes with different renal trajectories and may support individualized HIV\u2013nephrology care in resource-constrained settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0000001332","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:00:27Z","timestamp":1787587227000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Renal Trajectories Across Histopathological Phenotypes in Treated HIV"],"prefix":"10.34067","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9737-0443","authenticated-orcid":false,"given":"Gustavo","family":"Casas-Aparicio","sequence":"first","affiliation":[{"name":"Department of Nephrology, Instituto Nacional de Enfermedades Respiratorias Ismael Cos\u00edo Villegas (INER), Mexico City, Mexico."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6371-9281","authenticated-orcid":false,"given":"Antonio","family":"Le\u00f3n-Ortiz","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Instituto Nacional de Enfermedades Respiratorias Ismael Cos\u00edo Villegas (INER), Mexico City, Mexico."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8277-7507","authenticated-orcid":false,"given":"Virgilia","family":"Soto-Abraham","sequence":"additional","affiliation":[{"name":"Department of Nephropathology, Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez, Mexico City, Mexico."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1590-4622","authenticated-orcid":false,"given":"Regina","family":"S\u00e1nchez-Becerrra","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Instituto Nacional de Enfermedades Respiratorias Ismael Cos\u00edo Villegas (INER), Mexico City, Mexico."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0205-817X","authenticated-orcid":false,"given":"Enzo V\u00e1squez","family":"Jimenez","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Ju\u00e1rez de M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3838-6378","authenticated-orcid":false,"given":"Joana Balderas","family":"Juarez","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Dr. Manuel Gea Gonz\u00e1lez"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0294-3790","authenticated-orcid":false,"given":"Melany","family":"Vivanco-Valenzuela","sequence":"additional","affiliation":[{"name":"Department of Nephropathology, Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez, Mexico City, Mexico."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo Salgado-Montes","family":"de Oca","sequence":"additional","affiliation":[{"name":"Center for Research in Infectious Diseases (CIENI), Instituto Nacional de Enfermedades Respiratorias Ismael Cos\u00edo Villegas (INER), Mexico City, Mexico."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,24]]},"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001332","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:00:27Z","timestamp":1787587227000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001332"}},"subtitle":["A Multicenter Biopsy-Based Observational Study"],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":0,"URL":"https:\/\/doi.org\/10.34067\/kid.0000001332","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"assertion":[{"value":"2026-04-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}