A 35-year-old African American man presents to the clinic with worsening fatigue, swelling in his legs, and foamy urine for the past two weeks. His medical history is significant for untreated HIV infection, diagnosed 5 years ago. He has not been taking antiretroviral therapy regularly. On physical examination, he has bilateral lower extremity edema and elevated blood pressure. Laboratory tests reveal heavy proteinuria, hypoalbuminemia, and elevated serum creatinine. A kidney biopsy confirms focal segmental glomerulosclerosis. The physician suspects a diagnosis related to his underlying HIV infection. Question: Which of the following best describes the pathophysiology of HIV-1–associated nephropathy (HIVAN)?
