Background Renal impairment in patients with HIV/AIDS is described since the beginning of pandemia. The incidence is increasing in the last 10 years by associated comorbidities: hypertension, diabetes, lipids disorders. In Romania there is a cohort (those born 1988–1990) around 9000 HIV -infected patients over 20 years old, which started antiretroviral therapy (ART) since 1996/1997.

Methods We studied an HIV case – white female, 22 years, from the nephrological perspective, with all complex comorbidities.

Results Our patient was diagnosed with AIDS at 11 years when she was admitted with toxoplasmic encephalitis, comatose. Since 2000 with ART. After that started ART side effects: hypercholesterolemia, hypertension, cardiomyopathy and an early renal failure. Renal impairment was detected at the age of 15 year with the GFR estimation (MDRD)-61 ml/min, with elevated blood pressure values. Treatment of complications was correction of dyslipidemia (Pravastatin + Ezetrol), intermittently diuretics, and from 2009 - Captopril. From 2012 she is in the C2 stage of HIV infection, RNA undetectable, CKD stage III (GFR-MDRD 36 ml/min). The renal biopsy performed revealed chronic glomerulopathy and diffuse global glomerulosclerosis. She present now osteopenia and a neurologic sequel (hemiparesis).

Conclusions Renal pathology is found in all stages of HIV infection. Biopsy is one that correctly diagnose the case even if the lesions are not patognomonic for HIVAN. The case is with a complex pathology related with the HIV infection. Renal impairment, a fact in these patients, often need renal replacement therapy (dialysis or renal transplantation), less than in US population confronted with a higher prevalence of HIVAN.