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Background:  The prevalence of HIV nephropathy in the pre-HAART era has been reported as 15% with a median age of onset of 30 months based upon proteinuria detected by urine dipstick. The objective of the study was to determine the prevalence of HIVN using random urine protein-creatinine ratio (U P/Cr) among HIV infected children on HAART.

Methods:  Retrospective, chart review of patients, from January 1998 to January 2003, of a single urban, tertiary care, clinic population of HIV-infected children in Miami in whom at least 2 measurements of U (P/Cr) were done. Persistent proteinuria was determined by U P/Cr >0.2 in 2 occasions at least 2 weeks apart in the absence of acute illness. Overt HIV nephropathy was defined as persistent proteinuria associated with renal ultrasound and/or scintigraphic changes. Severity of HIV nephropathy was assessed by a scoring system based on proteinuria (values of  U P/Cr), renal function (serum Cr /Schwartz formula), radiological studies (ultrasonography and scintigraphy), and histopathologic changes.

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Results:  Of 315 patients followed, 286 were included since they had at least 1 or more measurement of U P/Cr. Of these 142 (49.7%) were male, 242 (86.5%) were black or African American; 92 (32.2%) were CDC category C3, and 244 (85.3%) were on HAART. Of 98 (34.3%) patients who had HIV nephropathy, the diagnosis of 59 (20.6%) was based on the presence of persistent proteinuria alone, while 39 (13.6%) had overt HIV nephropathy. Of the 39 patients with overt HIV nephropathy, the mean age at diagnosis was 8.7 years, 26 (66.6%) were male, 36 (92.3%) were black or African American, and 35 (87.7%) had C3 disease. HIV nephropathy was more prevalent in patients with C3 disease independently of other factors. As for outcome, 12 (31%) patients progressed to chronic renal insufficiency and 3 required dialysis. Mortality was 15.4 %; mortality adjusted for C3 category with HIV nephropathy was 21.4, much higher than mortality for category C3 without HIVN that was 7.4% (Z test 1.84, p = 0.07, CI 95%). Severity of HIV nephropathy correlated significantly with persistent high viral load (r = 0.74; p <0.0001). Two patients developed overt HIV nephropathy despite good viral load control (<2.3 log). There was no correlation with T-cell counts at the time of diagnosis.

Conclusions:  Screening for quantitative proteinuria in urine and radiological imaging is essential for the early diagnosis of HIV nephropathy because severity of HIV nephropathy correlates significantly with high viral load and C3 disease. The introduction of HAART has delayed the appearance of HIV nephropathy (from 2.5 years to 8.7 years), but without substantial reduction in its prevalence.

Keywords: HIV Nephropathy