Uremic syndrome with newly diagnosed HIV infection: reflections on a particular case

Abstract

Introduction: Diagnosis with Western blot test (WB) may not provide clear results for certain patients, including those who are not infected with human immunodeficiency virus (HIV) but produce non-specific reactions, individuals in the HIV window period (WP), those with acute HIV infection, and advanced acquired immunodeficiency syndrome (AIDS) patients. HIV-positive individuals face an elevated risk of developing kidney disease. HIV peritoneal dialysis patients may be more susceptible to catheter-related infections. This study reports a case of HIV detected during early development of a nephrotic syndrome into uremic syndrome.

Case presentation: A 46-year-old male individual diagnosed with stage 5 chronic kidney disease was admitted to the hospital in preparation for his first renal replacement therapy. During routine check-ups, the patient was identified as having a reactive response to the HIV antigen/antibody test. The rapid detection results exhibited a weak reaction across all manufacturers, while the enzyme-linked immunosorbent assay (ELISA) test (Bio-Rad, Hercules, USA) showed a reactive response. Nonetheless, the third and fourth generation tests did not yield a response, suggesting that the patient`s internal concentration of HIV antigen or antibody was relatively low at the time. However, the confirmation test did not provide conclusive results, leading the patient to decline further renal replacement therapy. Two months later, the patient`s HIV antigen/antibody levels were measured as 95.23 in the outpatient department of our hospital.

Conclusions: This case underscores the importance of actively exploring various detection strategies to enhance the efficiency of detecting acute phase HIV infection during the testing process.

Keywords: HIV; hemodialysis; peritoneal dialysis; uremic syndrome.