The Evolution of Our Knowledge of HIV-Associated Kidney Disease in Africa  Charles R. Swanepoel, FRCP Edin, Nicola Wearne, FCP(SA), Maureen S. Duffield, MMedPath (Anat) UCT, MRCPath, Ikechi G. Okpechi, FWACP, PhD  American Journal of Kidney Diseases  Volume 60, Issue 4, Pages 668-678 (October 2012) DOI: 10.1053/j.ajkd.2012.04.034 Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 The origins of the human immunodeficiency virus (HIV) epidemic in Africa. Reproduced from www.avert.org15 with permission of AVERT (Averting HIV and AIDS). American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 (A) Collapsing focal segmental glomerulosclerosis with protein reabsorption granules within podocytes (center) (hematoxylin and eosin stain; original magnification, ×400) (B) Prominent epithelial cells surround a collapsed glomerulus. This lesion can be confused with a crescent (pseudocrescent) (hematoxylin and eosin stain; original magnification, ×400). American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 The glomerulus shows global collapse and prominence of the epithelial cells. This resembles the histologic configuration of a fetal glomerulus (hematoxylin and eosin stain; original magnification, ×400). American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Typical microcysts. Massively distended tubules with atrophied and flattened epithelial cells. They contain acellular eosinophilic material (hematoxylin and eosin stain; original magnification, ×400). American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 5 (A) Large subepithelial deposits surrounded by basement membrane extensions can be seen at original magnification ×400 on light microscopy. These deposits usually are larger than the typical subepithelial deposits seen in membranous glomerulopathy, but are more numerous than in postinfectious glomerulonephritis (hematoxylin and eosin stain). (B) Immunohistochemistry staining is positive for immunoglobulin G (and C3; not shown); original magnification, ×400. (C, D) These lesions are best resolved and identified at the ultrastructural level (electron microscopy; original magnification, ×20,000 [D]; ×15,000 [E]). American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 6 Time to death due to renal causes for HIVAN (human immunodeficiency virus–associated nephropathy) during a 24-month period. Comparison between the time that combination antiretroviral therapy (cART) was not available to when it was introduced. Adapted and reproduced from Wearne et al26 with permission of the European Renal Association–European Dialysis and Transplant Association. American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 7 Cartoon that mocks former South African Minister of Health Dr “Manto” Tshabalala-Msimang's “treatment” for human immunodeficiency virus infection. Reproduced from www.zapiro.com28 with permission of Zapiro. © 2004-2011 Zapiro (all rights reserved). American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 8 Distribution of health workers by level of health expenditure and burden of disease, by World Health Organization (WHO) region. Reproduced from WHO36 with permission. American Journal of Kidney Diseases 2012 60, 668-678DOI: (10.1053/j.ajkd.2012.04.034) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions