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Nkoy AB, Ekulu PM, Labarque V, Van den Heuvel LP, Levtchenko EN. HIV-associated nephropathy in children: challenges in a resource-limited setting. Pediatr Nephrol 2023; 38:2509-2521. [PMID: 36472655 DOI: 10.1007/s00467-022-05819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
HIV infection remains one of the leading causes of morbidity and mortality worldwide, especially in children living in resource-limited settings. Although the World Health Organization (WHO) recently recommended antiretroviral therapy (ART) initiation upon diagnosis regardless of the number of CD4, ART access remains limited, especially in children living in sub-Saharan Africa (SSA). HIV-infected children who do not receive appropriate ART are at increased risk of developing HIV-associated nephropathy (HIVAN). Although due to genetic susceptibility, SSA is recognized to be the epicenter of HIVAN, limited information is available regarding the burden of HIVAN in children living in Africa. The present review discusses the information available to date on the prevalence, pathogenesis, risk factors, diagnosis, and management of HIVAN in children, focusing on related challenges in a resource-limited setting.
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Affiliation(s)
- Agathe B Nkoy
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Pépé M Ekulu
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Veerle Labarque
- Department of Pediatric Hematology, University Hospital Leuven, Leuven, Belgium
- Center of Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lambertus P Van den Heuvel
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Elena N Levtchenko
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.
- Department of Pediatric Nephrology, University Hospital Leuven, Leuven, Belgium.
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Al Hammoud R, Kalaskar A, Rodriguez G, Del Bianco G, Bell C, Murphy JR, Heresi GP. Microalbuminuria in Perinatally HIV-Infected Children and Adolescents in the United States. Open Forum Infect Dis 2023; 10:ofad333. [PMID: 37426950 PMCID: PMC10326675 DOI: 10.1093/ofid/ofad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023] Open
Abstract
Background The kidney is a common target for human immunodeficiency virus (HIV), making renal disease a common noninfectious complication of HIV. Microalbuminuria is an important marker that can detect early renal damage. Timely detection of microalbuminuria is important to initiate renal management and stop the progression of renal dysfunction in people with HIV. Limited data are available about renal abnormalities in people with perinatal HIV infection. The objective of this study was to determine the prevalence of microalbuminuria in a cohort of perinatally HIV-infected children and young adults receiving combination antiretroviral therapy and investigate correlations between microalbuminuria and clinical and laboratory findings. Methods This was a retrospective study of 71 patients with HIV followed in an urban pediatric HIV clinic in Houston, Texas, between October 2007 and August 2016. Demographic, clinical, and laboratory data were compared between subjects with persistent microalbuminuria (PM) and those without. PM is defined as a microalbumin-to-creatinine ratio ≥30 mg/g on at least 2 occasions separated by at least 1 month. Results Sixteen of 71 patients (23%) met the definition of PM. In univariate analysis, patients with PM had significantly higher CD8+ T-cell activation and lower CD4+ T-cell nadir. Multivariate analysis demonstrated increased microalbuminuria to be independently associated with older age and CD8+ T-cell activation measured as CD8+HLA-DR+ T-cell percentage. Conclusions Older age and increased activation of CD8+HLA-DR+ on T cells correlate with presence of microalbuminuria in this cohort of HIV-infected patients.
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Affiliation(s)
- Roukaya Al Hammoud
- Correspondence: Roukaya Al Hammoud, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 (); Gloria P. Heresi, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 ()
| | - Anupama Kalaskar
- Pediatric Infectious Diseases, Children's Minnesota, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gilhen Rodriguez
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Gabriela Del Bianco
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Cynthia Bell
- Department of Pediatrics, McGovern Medical School at UTHealth Houston, Texas, USA
| | - James R Murphy
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Gloria P Heresi
- Correspondence: Roukaya Al Hammoud, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 (); Gloria P. Heresi, MD, Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, and Children's Memorial Hermann Hospital, 6431 Fannin St, 3.126, Houston, TX 77030 ()
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Imani PD, Elyanu PJ, Wanless RS, Perry SH, Katembo K, Lukhele B, Steffy T, Seetane T, Thahane L, Haq H, Bell CS, Srivaths P, Braun MC. Chronic kidney disease among children living with the human immunodeficiency virus in sub-Saharan Africa. JOURNAL OF CLINICAL VIROLOGY PLUS 2022. [DOI: 10.1016/j.jcvp.2022.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kiggundu T, Kalyesubula R, Andia-Biraro I, Makanga G, Byakika-Kibwika P. Prevalence of microalbuminuria and associated factors among HIV - infected ART naïve patients at Mulago hospital: a cross-sectional study in Uganda. BMC Nephrol 2020; 21:440. [PMID: 33081706 PMCID: PMC7574295 DOI: 10.1186/s12882-020-02091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background HIV infection affects multiple organs and the kidney is a common target making renal disease, one of the recognized complications. Microalbuminuria represents an early, important marker of kidney damage in several populations including HIV-infected antiretroviral therapy (ART) naïve patients. Early detection of microalbuminuria is critical to slowing down progression to chronic kidney disease (CKD) in HIV-infected patients, however, the burden of microalbuminuria in HIV-infected antiretroviral therapy (ART) naïve patients in Uganda is unclear. Methods A cross-sectional study was conducted in the Mulago Immune suppression syndrome (ISS) clinic among adult HIV − infected ART naïve outpatients. Data on patient demographics, medical history was collected. Physical examination was performed to assess body mass index (BMI) and hypertension. A single spot morning urine sample from each participant was analysed for microalbuminuria using spectrophotometry and colorimetry. Microalbuminuria was defined by a urine albumin creatinine ratio (UACR) 30-299 mg/g and macroalbuminuria by a UACR > 300 mg/g. To assess the factors associated with microalbuminuria, chi-square, Fisher’s exact test, quantile regression and logistic regression were used. Results A total of 185 adult participants were consecutively enrolled with median age and CD4+ counts of 33(IQR = 28–40) years and 428 (IQR = 145–689) cells/μL respectively. The prevalence of microalbuminuria was 18.9% (95% CI, 14–25%). None of the participants had macroalbuminuria. CD4+ count <350cells/μL was associated with increased risk of microalbuminuria (OR: 0.27, 95% CI: 0.12–0.59), P value = 0.001). Diabetes mellitus, hypertension, smoking, alcohol intake were not found to be significantly associated with microalbuminuria. Conclusion Microalbuminuria was highly prevalent in adult HIV − infected ART naive patients especially those with low CD4+ count. There is need to study the effect of ART on microalbuminuria in adult HIV − infected patients.
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Affiliation(s)
- Thomas Kiggundu
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. .,Department of Internal Medicine, Uganda Martyrs Hospital, Lubaga, P.O. Box 14130, Kampala, Uganda.
| | - Robert Kalyesubula
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Department of Physiology, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Gyaviira Makanga
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Bank of Uganda, P.O. Box 7120, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Institute, Makerere University, P.O. Box 7072, Kampala, Uganda
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Chami N, Kabyemera R, Masoza T, Ambrose E, Kimaro F, Kayange N, Hokororo A, Furia FF, Peck R. Prevalence and factors associated with renal dysfunction in children admitted to two hospitals in northwestern Tanzania. BMC Nephrol 2019; 20:79. [PMID: 30836938 PMCID: PMC6402082 DOI: 10.1186/s12882-019-1254-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is evident that renal dysfunction (RD) is associated with unique infectious and non-infectious causes in African children. However, little data exists about the prevalence and factors associated with RD in children admitted to African hospitals. METHODS In this cross-sectional study, we enrolled all children admitted to pediatric wards of Bugando Medical Centre (BMC) and Sekou-Toure Regional Referral hospital (SRRH) during a 6 month time period. Socio-demographical, clinical and laboratory data were collected using a structured questionnaire. Estimated glomerular filtration rate (eGFR) was calculated using modified Schwartz equation and those with < 60 ml/min/1.73m2were considered to have RD. Data analysis was done using STATA version 13 and considered significant when p-value was < 0.05. RESULTS A total of 513 children were enrolled, of which 297 (57.9%) were males. Median age of children with and without RD was 34 months (27-60) and 46.5 (29-72) respectively. Prevalence of RD was 16.2%. Factors associated with RD were herbal medication use (p = 0.007), history of sore throat or skin infection (p = 0.024), sickle cell disease (SCD) (p = 0.006), dehydration (p = 0.001), malaria (p = 0.01) and proteinuria (p = < 0.001). CONCLUSIONS High prevalence of RD was observed among children admitted to referral hospitals in Mwanza. Screening for RD should be performed on admitted children, particularly those with history of herbal medication use, sore throat/skin infection, SCD, dehydration and malaria. Where creatinine measurement is not possible, screening for proteinuria is a reasonable alternative.
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Affiliation(s)
- Neema Chami
- Department of Pediatrics and Child Health, Bugando Medical Centre, P. O. Box 1370, Mwanza, Tanzania
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
| | - Rogatus Kabyemera
- Department of Pediatrics and Child Health, Bugando Medical Centre, P. O. Box 1370, Mwanza, Tanzania
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
| | - Tulla Masoza
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
| | - Emmanuela Ambrose
- Department of Pediatrics and Child Health, Bugando Medical Centre, P. O. Box 1370, Mwanza, Tanzania
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
| | - Franscisca Kimaro
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
- Department of Pediatrics and Child Health, College of Health Sciences-University of Dodoma, P. O. Box 395, Dodoma, Tanzania
| | - Neema Kayange
- Department of Pediatrics and Child Health, Bugando Medical Centre, P. O. Box 1370, Mwanza, Tanzania
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
| | - Adolfine Hokororo
- Department of Pediatrics and Child Health, Bugando Medical Centre, P. O. Box 1370, Mwanza, Tanzania
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
| | - Francis F. Furia
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es salaam, Tanzania
| | - Rob Peck
- Department of Pediatrics and Child Health, Bugando Medical Centre, P. O. Box 1370, Mwanza, Tanzania
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, P. O. Box 1464, Mwanza, Tanzania
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Frigati L, Mahtab S, Nourse P, Ray P, Perrazzo S, Machemedze T, Agyei NAA, Cotton M, Myer L, Zar H. Prevalence of risk factors for chronic kidney disease in South African youth with perinatally acquired HIV. Pediatr Nephrol 2019; 34:313-318. [PMID: 30219929 PMCID: PMC6529608 DOI: 10.1007/s00467-018-4080-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/06/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about renal pathology among perinatally HIV-infected children and adolescents in Africa. We assessed the prevalence of risk factors for chronic kidney disease in South African children and adolescents with perinatally acquired HIV-1 (HIV+) on antiretroviral therapy (ART) and HIV-negative children and adolescents. METHODS HIV+ youth aged 9-14 years, on ART for > 6 months and age-matched HIV-negative children and adolescents were eligible for assessment of proteinuria and microalbuminuria using urine dipstick and Vantage analyser method. Blood pressure, estimated glomerular filtration rate, HIV-related variables and metabolic co-morbidities were assessed at enrolment. RESULTS Among 620 children and adolescents, 511 were HIV+. The median age was 12.0 years and 50% were female. In HIV+ children and adolescents, 425 (83.2%) had a CD4 count > 500 cells/mm3 and 391 (76.7%) had an undetectable viral load. The median duration of ART was 7.6 years (IQR 4.6-9.3) with 7 adolescents receiving Tenofovir. The prevalence of any proteinuria, microalbuminuria and hypertension was 6.6%, 8.5% and 13.9%, respectively, with no difference between HIV+ and negative children and adolescents. All participants had a normal glomerular filtration rate. There was no association between metabolic co-morbidities and microalbuminuria. CONCLUSIONS Proteinuria and microalbuminuria appear to be uncommon in this population. Follow up of those with microalbuminuria may inform long-term outcomes and management of this growing population of HIV+ youth.
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Affiliation(s)
- Lisa Frigati
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
- Research Centre for Adolescent and Child Health (REACH) and Medical Research (MRC) Unit on Child and Adolescent Health, Department of Pediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa.
| | - Sana Mahtab
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Peter Nourse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Patricio Ray
- Center for Genetic Medicine Research and Division of Nephrology, Children's National Medical Center, and Department of Pediatrics, The George Washington University, Washington DC, WA, USA
| | - Sofia Perrazzo
- Center for Genetic Medicine Research and Division of Nephrology, Children's National Medical Center, and Department of Pediatrics, The George Washington University, Washington DC, WA, USA
| | - Takwanisa Machemedze
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nana-Akua Asafu Agyei
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mark Cotton
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, Cape Town, South Africa
| | - Heather Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Research Centre for Adolescent and Child Health (REACH) and Medical Research (MRC) Unit on Child and Adolescent Health, Department of Pediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
- MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Malnutrition, Growth Response and Metabolic Changes Within the First 24 Months After ART Initiation in HIV-infected Children Treated Before the Age of 2 Years in West Africa. Pediatr Infect Dis J 2018; 37:781-787. [PMID: 29406463 DOI: 10.1097/inf.0000000000001932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is limited information about malnutrition, growth evolution and metabolic changes among children initiated early on lopinavir-based antiretroviral therapy (ART) in Africa. METHODS HIV-1-infected children, age <2 years were initiated on ART, as part of the MONOD ANRS 12206 project, conducted in Burkina Faso and Côte d'Ivoire. Weight-for-age, height-for-age and weight-for-height Z scores defined malnutrition [Z score less than -2 standard deviations (SDs)] using World Health Organization growth references. Biologic data were collected every 6 months. Factors associated with baseline malnutrition were evaluated using multivariate logistic regression, and with growth evolution in the first 24 months on ART using linear mixed models. RESULTS Between 2011 and 2013, 161 children were enrolled: 64% were from Abidjan, 54% were girls. At ART initiation, median age was 13.7 months (interquartile range 7.7; 18.4), 52% were underweight (weight-for-age), 52% were stunted (height-for-age) and 36% were wasted (weight-for-height). Overall, baseline malnutrition was more likely for children living in Burkina Faso, with low birth weight, never breastfed and older age (12-24 months). Growth improved on ART, mainly within the first 6 months for weight, and was greater for the most severely malnourished children at baseline, but 8%-32% remained malnourished after 24 months. Over the 24-month period of ART, there was a significant increase of hypercholesterolemia and decrease of anemia and hypoalbuminemia. CONCLUSIONS Prevalence of malnutrition was high before ART initiation. Even though growth improved on ART, some children remained malnourished even after 2 years of ART, highlighting the need for more active nutritional support.
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Husain NE, Ahmed MH, Almobarak AO, Noor SK, Elmadhoun WM, Awadalla H, Woodward CL, Mital D. HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention. J Clin Med Res 2018; 10:1-8. [PMID: 29238427 PMCID: PMC5722038 DOI: 10.14740/jocmr3235w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/06/2017] [Indexed: 01/28/2023] Open
Abstract
The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "HIVAN" and "pathology and clinical presentation", in addition to "prevalence and risk factors for HIVAN", with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/µL. Other clinical presentations in African populations include acute kidney injury (AKI), nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN.
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Affiliation(s)
- Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Ahmed O. Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Sufian K. Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Wadie M. Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Clare L. Woodward
- Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Dushyant Mital
- Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
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Abstract
Human immunodeficiency virus (HIV) infection continues to be a leading cause of morbidity and mortality. HIV-infected individuals are now surviving for a relatively longer period and this is because of easy accessibility to antiretroviral therapy these days. As a result, chronic disease-related complications are now being recognized more often. Kidney disease in HIV-infected children can vary from glomerular to tubular-interstitial involvement. We searched the database to identify various kidney diseases seen in HIV-infected children. We describe the epidemiology, pathogenesis, pathology, clinical and laboratory manifestations, management and outcome of commonly seen kidney disease in HIV-infected children. We also provide a brief overview of toxicity of antiretroviral drugs seen in HIV-infected children. Kidney involvement in HIV-infected children may arise because of HIV infection per se, opportunistic infections, immune mediated injury and drug toxicity. HIV-associated nephropathy is perhaps the most common and most severe form of kidney disease. Proteinuria may be a cost-effective screening test in the long-term management of HIV-infected children, however, there are no definite recommendations for the same. Other important renal diseases are HIV immune complex kidney disease, thrombotic microangiopathy, interstitial nephritis and vasculitis.
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Affiliation(s)
- Ankur Kumar Jindal
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Karalanglin Tiewsoh
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Rakesh Kumar Pilania
- a Department of Paediatrics, Allergy Immunology and Nephrology Unit , Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Sharma G, Mathai SS. Prevalence of Asymptomatic Microalbuminuria in HIV Positive Children in India. Indian J Pediatr 2017; 84:417-419. [PMID: 28176231 DOI: 10.1007/s12098-017-2294-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the prevalence of covert or early renal involvement among human immunodeficiency virus (HIV) positive children. METHODS A cross-sectional observational study was carried out on 250 HIV positive children (2-18 y) on follow-up in a tertiary care hospital from January 2014 through June 2015. Those who met the study criteria were evaluated for microalbuminuria and glomerular and tubular dysfunctions. RESULTS Fifty-one out of two hundred fifty (20%) children were found to have microalbuminuria though none had any other evidence of renal dysfunction. The incidence of microalbuminuria in children on Anti Retroviral Therapy (ART) and those not on ART was 20% and 21% respectively. Neither was there any difference in those with a CD4 count ≤500/cu mm compared with those with counts >500/cu mm. However, the overall CD4 counts were significantly lower in children with microalbuminuria. CONCLUSIONS Microalbuminuria was detected in 20% of asymptomatic HIV positive children suggesting early glomerular dysfunction and need for regular screening and follow-up.
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Affiliation(s)
- Gorav Sharma
- Department of Pediatrics, Armed Forces Medical College, Wanowrie PO, Pune, Maharashtra, 411040, India
| | - Sheila S Mathai
- Department of Pediatrics, Armed Forces Medical College, Wanowrie PO, Pune, Maharashtra, 411040, India.
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