Pediatric Nephrology

, Volume 27, Issue 6, pp 981–989

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

  • Murli U. Purswani
  • Miriam C. Chernoff
  • Charles D. Mitchell
  • George R. SeageIII
  • Gaston Zilleruelo
  • Carolyn Abitbol
  • Warren A. Andiman
  • Kathleen A. Kaiser
  • Hans Spiegel
  • James M. Oleske
  • The IMPAACT 219/219C Study Team
Original Article

DOI: 10.1007/s00467-011-2097-1

Cite this article as:
Purswani, M.U., Chernoff, M.C., Mitchell, C.D. et al. Pediatr Nephrol (2012) 27: 981. doi:10.1007/s00467-011-2097-1

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.

Keywords

HIVANHIV immune complex kidney diseaseFSGSRenalYouthProteinuriaBiopsy

Supplementary material

467_2011_2097_MOESM1_ESM.doc (249 kb)
ESM 1Renal event report: Questionnaire mailed to the clinical research sites (DOC 249 kb)
467_2011_2097_MOESM2_ESM.doc (64 kb)
ESM 2Fig. 1 Identification of 27 cases of chronic kidney disease associated with HIV, PACTG 219/219C cohort, 1993–2006 (DOC 64.5 kb)
467_2011_2097_MOESM3_ESM.docx (14 kb)
ESM 3Table: Univariate Poisson regression analysis of characteristics and incidence rates for chronic kidney disease associated with HIV, PACTG 219/219C Cohort, 1993 through 2004 (DOCX 14.1 kb)
467_2011_2097_MOESM4_ESM.doc (34 kb)
ESM 4Acknowledgements (DOC 34.0 kb)

Copyright information

© IPNA 2012

Authors and Affiliations

  • Murli U. Purswani
    • 1
  • Miriam C. Chernoff
    • 2
  • Charles D. Mitchell
    • 3
  • George R. SeageIII
    • 2
    • 4
  • Gaston Zilleruelo
    • 5
  • Carolyn Abitbol
    • 5
  • Warren A. Andiman
    • 6
  • Kathleen A. Kaiser
    • 7
  • Hans Spiegel
    • 8
  • James M. Oleske
    • 9
  • The IMPAACT 219/219C Study Team
  1. 1.Department of Pediatrics, Bronx-Lebanon Hospital CenterAlbert Einstein College of MedicineBronxUSA
  2. 2.Center for Biostatistics in AIDS Research, Harvard School of Public HealthBostonUSA
  3. 3.Division of Infectious Diseases and Immunology, Department of Pediatrics, Batchelor Children’s Research InstituteUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  5. 5.Division of Pediatric Nephrology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiUSA
  6. 6.Departments of Pediatrics and EpidemiologyYale University School of Medicine and School of Public HealthNew HavenUSA
  7. 7.Frontier Science and Technology Research FoundationAmherstUSA
  8. 8.Microbicide Research Branch, Prevention Science Program, Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID)BethesdaUSA
  9. 9.Department of PediatricsUniversity of Medicine and Dentistry of New Jersey, New Jersey Medical SchoolNJUSA