Proteinuria in children infected with the human immunodeficiency virus.
OBJECTIVE
To determine the prevalence of proteinuria in a large cohort of children infected with the human immunodeficiency virus (HIV) and their longitudinal progression during treatment with highly active antiretroviral therapy.


METHODS
In a retrospective cohort study, 286 children infected with HIV were monitored with quantitative assays of proteinuria from January 1998 through January 2007, with monitoring of viral load, lymphocyte profiles, kidney function, and mortality rates. Proteinuria was quantitated by urine protein to creatinine ratio (Upr/cr).


RESULTS
Ninety-four (33%) had proteinuria at baseline. Of these, 32 (11.2%) had nephrotic range proteinuria (Upr/cr > or = 1.0). Initial screening was at 11 +/- 0.3 years of age, with an average follow-up of 5.6 +/- 0.1 years. The mortality rate was significantly greater in those with proteinuria. During the period of observation, 15 patients with nephrotic proteinuria died or had development of end-stage renal disease, and 16 showed improvement. Of those with intermediate range proteinuria (Upr/cr > or = 0.2 < 1.0), 3 progressed to nephrotic range proteinuria, and 39 (63%) showed resolution of the proteinuria (Upr/cr < 0.2). Improvement in proteinuria was correlated with decreasing viral load (r = 0.5; P < .01).


CONCLUSIONS
Control of viral load with highly active antiretroviral therapy appears to prevent the progression of HIV-associated renal disease and improve survival rates in infected children.
Chaparro
Aida I
AI
Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Miami, Miami, FL, USA.
Mitchell
Charles D
CD
Abitbol
Carolyn L
CL
Wilkinson
James D
JD
Baldarrago
Giovanna
G
Lopez
Erika
E
Zilleruelo
Gastón
G
D016263:AIDS-Associated Nephropathy / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D015497:HIV-1; D006801:Humans; D008297:Male; D015995:Prevalence; D011507:Proteinuria / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors