title: Chronic kidney disease associated with perinatal HIV infection in children and adolescents.
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.
authors.affiliation: Department of Pediatrics, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA. mpurswan@bronxleb.org
authors.forename: Murli U
authors.initials: MU
authors.lastname: Purswani
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Chernoff
authors.forename: Charles D
authors.initials: CD
authors.lastname: Mitchell
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
authors.forename: Warren A
authors.initials: WA
authors.lastname: Andiman
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Kaiser
authors.forename: Hans
authors.initials: H
authors.lastname: Spiegel
authors.forename: James M
authors.initials: JM
authors.lastname: Oleske
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000254:growth & development / Q000472:pathogenicity*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011647:Puerto Rico / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019562:Viral Load; D014779:Virus Replication