Chronic kidney disease associated with perinatal HIV infection in children and adolescents

Pediatr Nephrol. 2012 Jun;27(6):981-9. doi: 10.1007/s00467-011-2097-1. Epub 2012 Feb 26.

Abstract

Background: This study describes the incidence, clinical and demographic characteristics, and spectrum of chronic kidney disease (CKD) in youths with perinatal HIV-1 infection.

Methods: Retrospective analysis between May 1993 and December 2006 of subjects with renal disease followed in the Pediatric AIDS Clinical Trials Group 219/219C multicenter study examining the long-term consequences of perinatal HIV infection. Diagnosis confirmation was made utilizing a questionnaire mailed to research sites. Participants with CKD of other etiology than HIV were excluded. Outcome measures were biopsy-diagnosed CKD and, in the absence of biopsy, HIV-associated nephropathy (HIVAN) using established clinical criteria.

Results: Questionnaires on 191 out of 2,102 participants identified 27 cases of CKD: 14 biopsy-diagnosed and 6 clinical cases of HIVAN, and 7 biopsy-diagnosed cases of immune complex-mediated kidney disease (lupus-like nephritis, 3; IgA nephropathy, 2; membranous nephropathy, 2). Incidence rates for CKD associated with HIV in pre-highly active antiretroviral therapy (HAART) (1993-1997) and HAART (1998-2002, 2003-2006) eras were 0.43, 2.84, and 2.79 events per 1,000 person years respectively. In multivariate analysis, black race and viral load ≥100,000 copies/mL (rate ratios 3.28 and 5.05, p ≤ 0.02) were associated with CKD.

Conclusions: A variety of immune complex-mediated glomerulonephritides and HIVAN occurs in this population. Black race and uncontrolled viral replication are risk factors for CKD associated with HIV.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Associated Nephropathy / diagnosis
  • AIDS-Associated Nephropathy / epidemiology*
  • AIDS-Associated Nephropathy / immunology
  • AIDS-Associated Nephropathy / virology
  • Adolescent
  • African Americans / statistics & numerical data
  • Age Factors
  • Biopsy
  • CD4 Lymphocyte Count
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Chronic Disease
  • Female
  • Glomerulonephritis / diagnosis
  • Glomerulonephritis / epidemiology*
  • Glomerulonephritis / immunology
  • Glomerulonephritis / virology
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • HIV Infections / immunology
  • HIV Infections / virology
  • HIV-1 / growth & development
  • HIV-1 / pathogenicity*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Linear Models
  • Male
  • Multicenter Studies as Topic
  • Multivariate Analysis
  • Puerto Rico / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors
  • United States / epidemiology
  • Viral Load
  • Virus Replication