title: Predictors of resolution and persistence of renal laboratory abnormalities in pediatric HIV infection.
abstract: BACKGROUND
  Among human immunodeficiency virus (HIV)-infected youth, the role of renal disease (RD) and its management has become increasingly important as these children/adolescents mature into young adults. The identification of predictors of abnormal renal laboratory events (RLE) may be helpful in the management of their HIV infection and its associated renal complications.
  
  
  METHODS
  Data collected from HIV-infected youth followed for ≥ 48 months were analyzed to identify predictors of resolution versus persistence of RLE and determine the utility of RLE to predict the onset of RD. Analysis included descriptive and inferential methods using a multivariable extended Cox proportional hazards model.
  
  
  RESULTS
  Of the 1,874 at-risk children enrolled in the study, 428 (23 %) developed RLE, which persisted in 229 of these (54 %). CD4 percentages of <25 % [hazard ratio (HR) 0.63, p < 0.002) and an HIV viral load of >100,000 copies/ml (HR 0.31, p < 0.01) were associated with reduced rates of resolution, while in most cases exposure to highly active antiretroviral therapy (HAART)/nephrotoxic HAART prior to or subsequent to RLE were not. Persistence of RLE was 88 % sensitive for identifying new RD. Negative predictive values for RD were >95 % for both the at-risk cohort and those with RLE.
  
  
  CONCLUSIONS
  Advanced HIV disease predicted persistence of RLE in HIV-infected youth. Persistent RLE were useful for identifying RD.
authors.affiliation: Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Miami Miller School of Medicine, Room 286, Batchelor Children's Research Institute, 1580 NW 10th Avenue, Miami, 33136, FL, USA, cmitchel@med.miami.edu.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Mitchell
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Chernoff
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Murli U
authors.initials: MU
authors.lastname: Purswani
authors.forename: Hans M L
authors.initials: HM
authors.lastname: Spiegel
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
authors.forename: Barbara
authors.initials: B
authors.lastname: Heckman
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Ponce
authors.forename: James M
authors.initials: JM
authors.lastname: Oleske
mesh_terms: D002648:Child; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology / Q000821:virology*; D007677:Kidney Function Tests; D008297:Male; D016016:Proportional Hazards Models; D019562:Viral Load