Hematuria, or blood in the urine, is a concerning symptom that warrants medical attention. It may be visible (gross hematuria) or only detectable through laboratory testing (microscopic hematuria). While human immunodeficiency virus (HIV) infection itself does not commonly cause blood to appear in the urine directly, it significantly increases the risk of secondary conditions that lead to hematuria. The presence of blood in the urine for a person with HIV requires a focused medical evaluation.
Hematuria as a Direct HIV Symptom
Hematuria is typically not considered a common or direct symptom of the initial, acute phase of HIV infection, nor is it a primary manifestation of chronic, well-managed HIV disease. The HIV virus primarily targets and compromises the immune system. It does not typically cause acute, widespread bleeding within the urinary tract.
One rare exception involves a syndrome observed in some patients with advanced HIV, characterized by painful urinary frequency and hematuria without a typical bacterial infection. This suggests a possible direct inflammatory effect of the virus on the bladder lining, though the exact mechanism is not fully clear. For the vast majority of people with HIV, hematuria points toward a secondary issue.
Secondary Urinary and Renal Complications in People with HIV
The primary link between HIV and hematuria lies in the secondary complications that arise from a weakened immune system or necessary treatment. These conditions range from infections to specific kidney diseases and medication side effects. A compromised immune system leaves the urinary tract and kidneys vulnerable to opportunistic infections.
These infections may include common bacterial urinary tract infections (UTIs) that are more likely to be severe or recurrent in people with HIV. Viral infections, such as those caused by cytomegalovirus (CMV) or the BK virus, can also affect the bladder and kidneys, potentially causing inflammation and bleeding. Certain malignancies associated with advanced HIV, like Kaposi’s sarcoma or non-Hodgkin lymphoma, can sometimes infiltrate the urinary tract or cause obstruction, leading to hematuria.
HIV-Associated Nephropathy (HIVAN)
HIV-Associated Nephropathy (HIVAN) is a specific kidney complication caused by the direct infection of renal cells by the HIV virus. While the most common presentation of HIVAN is significant proteinuria, it can also present with microscopic hematuria. HIVAN is a serious condition that can rapidly progress to end-stage renal disease. Its incidence has significantly decreased with the widespread use of effective antiretroviral therapy (ART).
Antiretroviral Therapy (ART) Side Effects
Antiretroviral therapy (ART) can also contribute to hematuria as a side effect. Certain medications, such as atazanavir, can lead to crystalluria, where the drug or its metabolites crystallize in the urine. These crystals can irritate the lining of the urinary tract or form stones, causing pain and blood in the urine. Tenofovir disoproxil fumarate (TDF), another ART component, is known to cause kidney toxicity that may indirectly involve hematuria as part of a broader kidney injury.
When Blood in Urine Requires Immediate Medical Attention
Any instance of hematuria, whether gross or microscopic, should prompt a medical evaluation regardless of an individual’s HIV status. Prompt diagnosis is particularly important in people with HIV, given the broader range of potential causes linked to their immune status or treatment regimen.
If gross hematuria is accompanied by other severe symptoms, urgent medical attention is necessary. These include the inability to urinate, the passage of large blood clots, or the presence of fever, chills, and severe pain in the back, side, or abdomen. These combinations of symptoms may indicate a serious infection, a severe kidney stone blocking the urinary flow, or another acute issue.
Common causes that affect all people include bacterial urinary tract infections, kidney stones, and trauma. More serious causes that must be ruled out are kidney or bladder cancer. It is important to communicate one’s HIV status and all current medications to the treating physician, as this information is crucial for accurately determining the cause and selecting the correct treatment path.