Answer: A, Collapsing FSGS
HIV-associated nephropathy classically demonstrates collapsing FSGS. Other features include increased proximal tubule protein resorption droplets, and microcystic tubular dilatation. While this disease has markedly diminished in the presence of highly active antiretroviral therapy (HAART), the rate is still high in areas of sub-Saharan Africa. Within the United States, approximately 90% of cases occur in African Americans and are associated with genetic mutations in the APOL1 gene (G1/G2 alleles). The typical presentation is that of nephrotic syndrome secondary to widespread foot process effacement seen by electron microscopy. Interestingly, the CD4 count has not shown to be correlated to the subsequent development of HIVAN.
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