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

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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.

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Research funding and support

Overall support for the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) was provided by the National Institute of Allergy and Infectious Diseases (NIAID; U01 AI068632), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Mental Health (NIMH; AI068632). This work was supported by the Statistical and Data Analysis Center at Harvard School of Public Health, under the National Institute of Allergy and Infectious Diseases cooperative agreement #5 U01 AI41110 with the Pediatric AIDS Clinical Trials Group (PACTG) and #1 U01 AI068616 with the IMPAACT Group. Support of the sites was provided by the National Institute of Allergy and Infectious Diseases (NIAID) and the NICHD International and Domestic Pediatric and Maternal HIV Clinical Trials Network funded by the NICHD (contract number N01-DK-9-001/HHSN267200800001C). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders were not involved in the design and conducting of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Murli U. Purswani, Miriam C. Chernoff, and Charles D. Mitchell had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

We would like to thank the children and families for their participation in PACTG 219/219C and the individuals and institutions involved in the conduct of 219/219C (ESM 4).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1685 Morris Avenue Suite 1G, Bronx, NY, 10457, USA

    Murli U. Purswani

  2. Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA

    Miriam C. Chernoff & George R. Seage III

  3. Division of Infectious Diseases and Immunology, Department of Pediatrics, Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, USA

    Charles D. Mitchell

  4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    George R. Seage III

  5. Division of Pediatric Nephrology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA

    Gaston Zilleruelo & Carolyn Abitbol

  6. Departments of Pediatrics and Epidemiology, Yale University School of Medicine and School of Public Health, New Haven, CT, USA

    Warren A. Andiman

  7. Frontier Science and Technology Research Foundation, Amherst, NY, USA

    Kathleen A. Kaiser

  8. Microbicide Research Branch, Prevention Science Program, Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, MD, USA

    Hans Spiegel

  9. Department of Pediatrics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, NJ, USA

    James M. Oleske

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  1. Murli U. Purswani
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  2. Miriam C. Chernoff
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  9. Hans Spiegel
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  10. James M. Oleske
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The IMPAACT 219/219C Study Team

Corresponding author

Correspondence to Murli U. Purswani.

Electronic supplementary material

Below are the links to the electronic supplementary material.

ESM 1

Renal event report: Questionnaire mailed to the clinical research sites (DOC 249 kb)

ESM 2

Fig. 1 Identification of 27 cases of chronic kidney disease associated with HIV, PACTG 219/219C cohort, 1993–2006 (DOC 64.5 kb)

ESM 3

Table: 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)

ESM 4

Acknowledgements (DOC 34.0 kb)

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Purswani, M.U., Chernoff, M.C., Mitchell, C.D. et al. Chronic kidney disease associated with perinatal HIV infection in children and adolescents. Pediatr Nephrol 27, 981–989 (2012). https://doi.org/10.1007/s00467-011-2097-1

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  • DOI: https://doi.org/10.1007/s00467-011-2097-1

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