Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy

Abstract

Access to highly active anti-retroviral therapy (HAART) has improved the prognosis of Nigerian children infected with the human immunodeficiency virus (HIV); thus, more children are surviving. Long-term exposure to HAART is potentially nephrotoxic. We therefore aimed at assessing the prevalence of renal disease in Nigerian children infected with HIV, who are on HAART. In this cross-sectional study, we studied children, aged ten months to 17 years, infected with HIV, attending the pediatric HIV clinics of the University of Benin Teaching Hospital. Demographic and clinical data were obtained by parental interview as well as from the medical records. Each child's urine was tested for albumin and microalbuminuria using multi test strips and mitral test strips, respectively. The serum creatinine level of each child was also estimated and used in calculating the glomerular filtration rate (GFR). Renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or the presence of microalbuminuria of ≥20 mg and/or GFR <60 mL/min/1.73 m 2 . Of the 99 children recruited, 60 were males and 39 were females. The mean age of the children was 6.6 ± 3.5 years. All the children were on HAART and 85% had acquired the HIV infection by vertical transmission. The overall prevalence of renal disease was 16.2%. Microalbuminuria was seen in 11 children with renal disease (11.1%); 3 of them had significant proteinuria. GFR of less than 60 mL/min/1.73 m 2 was seen in five children (5.1%) with renal disease, but none had end-stage renal disease (GFR less than 15 mL/min/1.73 m 2 ). Renal disease was found to be significantly associated with advanced stage of HIV infection (P < 0.049). Our study showed that t he prevalence of renal disease in HAART-treated Nigerian children is high and majority of them are asymptomatic of renal disease, but in the advanced stages of HIV infection.

Renal abnormalities among HIV-infected, antiretroviral naive children, Harare, Zimbabwe: a cross-sectional study

“…In Sub-Saharan Africa, there are a few studies which describe the extent of renal disease in HIV-infected children. In Nigeria, Iduoriyekemwen et al found the prevalence of renal disease in HIV-infected children on highly active antiretroviral therapy (HAART) to be 16.2% [8]. Some of the studies in sub-Saharan Africa focused on proteinuria since it has been shown to be an early marker for HIVAN.…”

Persistent proteinuria as an indicator of renal disease in HIV-infected children

“…However, the study only evaluated a single measurement of microalbuminuria. 19 Low prevalence in our study was associated with lower risk factors observed in subjects, for example, younger age, 3,11 non-advanced clinical staging, 9,31 high CD4 cell count, 9,11,18 and already having received antiretroviral therapy at the time of study. 7,17 We found no relationships between persistent proteinuria and age, clinical stage, immunological classification, or duration of ARV.…”

“…In subjects with abnormalities of the kidney, 87.5% had been taking ARV < 5 years. 19 The use of antiretroviral drugs affected the low prevalence of proteinuria in this study because all subjects included in the final evaluation had been on ARV. ARV therapy restores renal epithelial changes characterized by a significant decrease in albuminuria.…”

“…In other studies where most subjects were on HAART for <5 years duration, the prevalence of microalbuminuria was 11.7%. 19 Uzoma et al reported that in 77.3% of children with HIV who took HAART, none had microalbuminuria. 17 Two subjects in this study had AKI.…”

“…11 Research on subjects who received ARV showed a significant correlation between clinical stage renal abnormalities and ARV (P<0.049). 19 Clinical stage and degree of immunosuppression further reflect the high number of HIV virus particles in the patient's body, aggravating the risk of renal cell injury as a result of the HIV virus. 3 The one subject with persistent proteinuria in our study had received ARV for 3 months.…”