26th June 2023

A 29-year-old man from West Africa is known to be HIV positive but is non-compliant with the antiretroviral therapy that he was commenced on at diagnosis.

A 29-year-old man from West Africa is known to be HIV positive but is non-compliant with the antiretroviral therapy that he was commenced on at diagnosis. He is complaining of lower limb oedema. Clinical observations are normal. He gives no history of recent illness, no pyrexia, and no history of foreign travel.
Blood and urine tests are shown below.

Urinalysis:
Protein +++
Glucose/ketones/leucocytes/blood – negative

Haemoglobin 104 g/dL
Urea – 3.4 mmoL/L
Creatinine – 78 μmol/L (around baseline)
Albumin – 45 g/L
CD4 count – 406 cells per cubic millimetre

Which of the following is most likely to be responsible for his clinical presentation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.