Prevalence and Factors Associated With Renal Dysfunction in HIV Positive Paediatric Patients on Highly Active Antiretroviral Therapy at the Paediatric Centre of Excellence of the University Teaching Hospital, in Lusaka, Zambia
Keywords:
Renal Dysfunction, Paediatric HIV patients, Highly Active Antiretroviral Therapy (HAART)
Abstract
Background- Although sub-Saharan Africa has the largest number of children living with the Human Immunodeficiency Virus (HIV), little is known about the prevalence of HIV related kidney disease in these children despite the recognition of HIV infection as a strong risk factor for kidney disease. This study investigated the prevalence and factors associated with renal dysfunction in HIV positive paediatric patients on highly active antiretroviral therapy at the Paediatric Centre of Excellence (PCOE) of the University Teaching Hospital (UTH), Lusaka, Zambia. Methodology- The study was a cross sectional survey conducted at the PCOE of the UTH in Lusaka, Zambia. Enrolment of all eligible participants was from April to September, 2014. The Inclusion criteria were patients aged 18 months to 16 years who consented or and assented to the study and were on HAART. Renal dysfunction was defined as at least abnormal renal laboratory values in at least 1 of 3 measures of proteinuria, serum creatinine or Estimated Glomerular Filtration Rate (eGFR) 60mL/min/1.73m2 for the age and height-adjusted value as defined by The Kidney Improving Global Outcomes (KDIGO) 2012 on two occasions. A file review and clinical evaluation was done by the study physician to determine the factors associated with renal dysfunction. Bloods were drawn for CD4 count, Haemoglobin (HB), Creatinine and Urine was taken for dipstick urinalysis. Results- Of the 209 participants enrolled in this cross sectional study, 105(50.2%) were females. This study found a prevalence of 8.1% (CI=5.0-12.5), of renal dysfunction among paediatric HIV patients followed up at PCOE. Children aged 13 and above had on average 23 times greater odds for renal dysfunction [adjusted odds ratio (OR) = 23.76, and 95% confidence interval (CI) = (5.30 – 106.53), P-value <0.01] compared to children under 13 years old. Children receiving nephrotoxic HAART had on average 6 times greater odds for renal dysfunction [OR=5.55, CI= (1.57 – 19.65), P-value = 0.01] compared to children receiving Non-Nephrotoxic HAART. Conclusion- The prevalence of renal dysfunction among paediatric HIV infected patients followed up at the PCOE at UTH in Lusaka Zambia is 8.1%, at 95% CI= (5.0-12.5) and associated factors include increase in age and nephrotoxic HAART.References
1. UNAIDS.AIDS epidemic update 2013.Available from:www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2013. Accessed on 2nd November 2014
2. Ray PE, Rakusan TM, Loechelt BJ, Selby DM, Liu X-H, Chandra RS. Human immunodeficiency virus (HIV)-associated nephropathy in the children from the Washington D.C. area; 12 Years’ experience. Semin Nephrol 1998;18:396–05. [PubMed: 9692352]
3. Benson C, Kaplan J, Masur H. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Clin Infect Dis 2005;40 (Suppl 1):S1–84. [PubMed: 15655768]
4. McCulloch MI. Introduction to paediatric HIV disease [abstract]. Pediatr Nephrol 2007;22:1438, 298.
5. Kala U, Petersen K, Faller G, Goetsch S. Spectrum of severe renal disease in children with HIV/Aids at Chris Hani Baragwanath Hospital, Johannesburg [abstract]. Pediatr Nephrol 2007;22:1439, 301.
6. Fauci SA. HIV-1 and AIDS. 20 years of science. Nat Med 2003;9:839–43. [PubMed: 12835701]
7. Ray PE, Xu L, Rakusan T, Liu XH. A 20 year history of childhood HIV-associated nephropathy. Pediatr Nephrol 2004;19:1075–92. [PubMed: 15300477]
8. Pardo VL, Meneses R, Ossa L, Jaffe DJ, Strauss J, Roth D, et al. AIDS-related glomerulopathy: occurrence in specific risk groups. Kidney Int 1987;31:1167–73. [PubMed: 3599656]
9. Strauss J, Abitbol CL, Zilleruelo G, Scott G, Paredes A, Malaga S, et al. Renal disease in children with the acquired immunodeficiency syndrome. N Engl J Med 1989;321:625–30. [PubMed: 2770791]
10. Connor E, Gupta S, Joshi V, DiCarlo F, Offenberger J, Minnefor A, et al. Acquired immunodeficiency syndrome associated renal disease in children. J Pediatr 1988;113:39–44. [PubMed: 3385527].
11. McConnell MS, Byers RH, Frederick T, et al. Trends in Antiretroviral Therapy Use and Survival Rates for a Large Cohort of HIVInfected Children and Adolescents in the United States, 1989–2001. J Acquir Immune Defic Syndr 2005;38:488-94.
12. Pardo V, Aldana M, Colton RM, Fischl MA, Jaffe D, Moskowitz L, et al. Glomerular lesions in the acquired immunodeficiency syndrome. Ann Intern Med 1984;101:429–34. [PubMed: 6476632].
13. Shah I, Gupta S, Shah DM, Dhabe H, Lala M: Renal manifestations of HIV-infected highly active antiretroviral therapy naïve children in India. World J Paediatr 2012, 8(3):252–5.
14. Chaparro AI, Mitchell CD, Abitbol CL, Wilkinson JD, Baldarragi G, Lopez E, et al. Proteinuria in children infected with the human immunodeficiency virus. J Pediatr 2008;152:844–9. [PubMed:18492529].
15. Ekulu PM, Nseka NM, Aloni MN, Gini JL, Makulo JR, Lepira FB, Sumali EK,Mafuta EM, Nsibu CN, Shiku JD: Prevalence of proteinuria and itsassociation with HIV/AIDS in Congolese children living in Kinshasa,Democratic Republic of Congo. Nephrol Ther 2012, 8(3):163–7.
16. Esezobor CI, Iroha E, Oladipo O, et al. Kidney function of HIV-infected children in Lagos, Nigeria: using Filler’s serum cystatin C- based forumular. J Int AIDS Soc 2010;13:17.
17. Nourse P, Bates W, Gajjar P, Sinclair P, Sinclair-Smith, McCulloch M. Paediatric HIV renal disease in Cape Town, South Africa [abstract]. Pediatr Nephrol 2007;22:1597, 750.
18. Gonzalez C, Arietta G, Langmann CB, Zibaoui P, Escalona L, Dominguez LF, et al. Hypercalciuria is the main renal abnormality finding in human immunodeficiency virus-infected children in Venezuela. Eur J Pediatr 2008;16:509–15. [PubMed: 17593389].
19. Friedman AL, Ray PE. Maintenance fluid therapy: what it is and what it is not. Pediatr Nephrol 2008;23:677–80. [PubMed: 17955266].
20. Hussain S, Khayat A, Tolaymat A, Rathmore MH. Nephrotoxicity in a child with perinatal HIV on tenofovir, didanosine and lopinavir/ritonavir. Pediatr Nephrol 2006;21:1034–6. [PubMed:16773419]
21. Dondo et al.: Renal abnormalities among HIVinfected, antiretroviral naive children, Harare, Zimbabwe: a crosssectional study. BMC Pediatrics 2013 13:75.
22. Jaroszewicz J, Wiercinska-Drapalo A, Lapinski TW, Prokopowicz D,Rogalska M, Parfieniuk A: Does HAART improve renal function? An association between serum cystatin C concentration, HIV viral load and HAART duration. Antivir Ther 2006, 11:641-645.
23. Eke FU, Anochie IC, Okpere AN, Eneh AU, Ugwu RN, Ejilemele AA, et al. Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria. Niger J Med 2010;19:298-301.
24. J. Banda et al 2010, prevalence and factors associated with renal dysfunction in HIV positive and negative adults at the UTH in Lusaka. Medical journal of Zambia. Vol37,number 3, 2010.
25. Pontrelli et al.: Renal function in HIV-infected children and adolescents treated with tenofovir disoproxil fumarate and protease inhibitors. BMC Infectious Diseases 2012 12:18.
2. Ray PE, Rakusan TM, Loechelt BJ, Selby DM, Liu X-H, Chandra RS. Human immunodeficiency virus (HIV)-associated nephropathy in the children from the Washington D.C. area; 12 Years’ experience. Semin Nephrol 1998;18:396–05. [PubMed: 9692352]
3. Benson C, Kaplan J, Masur H. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Clin Infect Dis 2005;40 (Suppl 1):S1–84. [PubMed: 15655768]
4. McCulloch MI. Introduction to paediatric HIV disease [abstract]. Pediatr Nephrol 2007;22:1438, 298.
5. Kala U, Petersen K, Faller G, Goetsch S. Spectrum of severe renal disease in children with HIV/Aids at Chris Hani Baragwanath Hospital, Johannesburg [abstract]. Pediatr Nephrol 2007;22:1439, 301.
6. Fauci SA. HIV-1 and AIDS. 20 years of science. Nat Med 2003;9:839–43. [PubMed: 12835701]
7. Ray PE, Xu L, Rakusan T, Liu XH. A 20 year history of childhood HIV-associated nephropathy. Pediatr Nephrol 2004;19:1075–92. [PubMed: 15300477]
8. Pardo VL, Meneses R, Ossa L, Jaffe DJ, Strauss J, Roth D, et al. AIDS-related glomerulopathy: occurrence in specific risk groups. Kidney Int 1987;31:1167–73. [PubMed: 3599656]
9. Strauss J, Abitbol CL, Zilleruelo G, Scott G, Paredes A, Malaga S, et al. Renal disease in children with the acquired immunodeficiency syndrome. N Engl J Med 1989;321:625–30. [PubMed: 2770791]
10. Connor E, Gupta S, Joshi V, DiCarlo F, Offenberger J, Minnefor A, et al. Acquired immunodeficiency syndrome associated renal disease in children. J Pediatr 1988;113:39–44. [PubMed: 3385527].
11. McConnell MS, Byers RH, Frederick T, et al. Trends in Antiretroviral Therapy Use and Survival Rates for a Large Cohort of HIVInfected Children and Adolescents in the United States, 1989–2001. J Acquir Immune Defic Syndr 2005;38:488-94.
12. Pardo V, Aldana M, Colton RM, Fischl MA, Jaffe D, Moskowitz L, et al. Glomerular lesions in the acquired immunodeficiency syndrome. Ann Intern Med 1984;101:429–34. [PubMed: 6476632].
13. Shah I, Gupta S, Shah DM, Dhabe H, Lala M: Renal manifestations of HIV-infected highly active antiretroviral therapy naïve children in India. World J Paediatr 2012, 8(3):252–5.
14. Chaparro AI, Mitchell CD, Abitbol CL, Wilkinson JD, Baldarragi G, Lopez E, et al. Proteinuria in children infected with the human immunodeficiency virus. J Pediatr 2008;152:844–9. [PubMed:18492529].
15. Ekulu PM, Nseka NM, Aloni MN, Gini JL, Makulo JR, Lepira FB, Sumali EK,Mafuta EM, Nsibu CN, Shiku JD: Prevalence of proteinuria and itsassociation with HIV/AIDS in Congolese children living in Kinshasa,Democratic Republic of Congo. Nephrol Ther 2012, 8(3):163–7.
16. Esezobor CI, Iroha E, Oladipo O, et al. Kidney function of HIV-infected children in Lagos, Nigeria: using Filler’s serum cystatin C- based forumular. J Int AIDS Soc 2010;13:17.
17. Nourse P, Bates W, Gajjar P, Sinclair P, Sinclair-Smith, McCulloch M. Paediatric HIV renal disease in Cape Town, South Africa [abstract]. Pediatr Nephrol 2007;22:1597, 750.
18. Gonzalez C, Arietta G, Langmann CB, Zibaoui P, Escalona L, Dominguez LF, et al. Hypercalciuria is the main renal abnormality finding in human immunodeficiency virus-infected children in Venezuela. Eur J Pediatr 2008;16:509–15. [PubMed: 17593389].
19. Friedman AL, Ray PE. Maintenance fluid therapy: what it is and what it is not. Pediatr Nephrol 2008;23:677–80. [PubMed: 17955266].
20. Hussain S, Khayat A, Tolaymat A, Rathmore MH. Nephrotoxicity in a child with perinatal HIV on tenofovir, didanosine and lopinavir/ritonavir. Pediatr Nephrol 2006;21:1034–6. [PubMed:16773419]
21. Dondo et al.: Renal abnormalities among HIVinfected, antiretroviral naive children, Harare, Zimbabwe: a crosssectional study. BMC Pediatrics 2013 13:75.
22. Jaroszewicz J, Wiercinska-Drapalo A, Lapinski TW, Prokopowicz D,Rogalska M, Parfieniuk A: Does HAART improve renal function? An association between serum cystatin C concentration, HIV viral load and HAART duration. Antivir Ther 2006, 11:641-645.
23. Eke FU, Anochie IC, Okpere AN, Eneh AU, Ugwu RN, Ejilemele AA, et al. Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria. Niger J Med 2010;19:298-301.
24. J. Banda et al 2010, prevalence and factors associated with renal dysfunction in HIV positive and negative adults at the UTH in Lusaka. Medical journal of Zambia. Vol37,number 3, 2010.
25. Pontrelli et al.: Renal function in HIV-infected children and adolescents treated with tenofovir disoproxil fumarate and protease inhibitors. BMC Infectious Diseases 2012 12:18.
Published
2020-06-30
How to Cite
1.
Zimba M, Chipeta J, Kankasa C. Prevalence and Factors Associated With Renal Dysfunction in HIV Positive Paediatric Patients on Highly Active Antiretroviral Therapy at the Paediatric Centre of Excellence of the University Teaching Hospital, in Lusaka, Zambia. Journal of Agricultural and Biomedical Sciences [Internet]. 30Jun.2020 [cited 21Nov.2024];4(2). Available from: https://journals.unza.zm/index.php/JABS/article/view/392
Section
Biomedical Sciences
Copyright: ©️ JABS. Articles in this journal are distributed under the terms of the Creative Commons Attribution License Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.