Background:  HIV-infected children are at risk for a number of renal complications, e.g., HIV-associated nephropathy. To describe associated renal diseases in HIV-infected children, clinical and laboratory diagnostic data from the PACTG219/219C dataset were analyzed.

Methods:  P219/219C is a prospective cohort study designed to assess the natural history and outcomes of HIV infection in children and the effects of ART. Children were evaluated every 3 to 6 months and standardized data collected. Clinical diagnoses were drawn from hospitalization diagnostics and symptom/sign databases. Patients with 3 sequentially abnormal renal lab values were considered to have persistent abnormalities.

Results:  We assessed 2103 HIV-infected children enrolled before December 31, 2004 and on study ³30 months. We identified in 129 HIV-infected study subjects, 22 different renal diagnoses and followed them for a mean of 6.6 years (13,827 total person-years). Of the 175 renal diagnoses reported, the most common were: nephropathy (n = 49; 28%), proteinuria (n = 23; 13%), nephrolithiasis (n = 22; 13%), and acute renal failure (n = 19; 11%); 97 patients had at least 1 of these 4 events. Persistent proteinuria (³ trace), high serum creatinine (↑CR), and decreased glomerular filtration rate (↓GFR) occurred in 171 (8%), 314 (15%), and 11 (1%) children, respectively. The frequency of combinations of abnormal renal lab values were:  persistent proteinuria only(145, 7%); ↑CR or ↓GFR only (288, 14%); persistent proteinuria, ↑CR, and ↓GFR (26, 1%). Persistent proteinuria preceded either ↑CR or ↓GFR in 16 of 26 (62%) instances. In 19% ↑CR or ↓GFR preceded persistent proteinuria. In another 19%, persistent proteinuria and ↑Cr or ↓GFR occurred within 90 days. Of 524 children with renal diagnoses or abnormal renal lab results, 64(12%) had both diagnoses and abnormal lab results. Of 459 children with any lab evidence of disease, 10 (2%) progressed to lab-defined HIV-associated nephropathy (persistent proteinuria ≥ 2+ and persistent ↑Cr/↓GFR). Of the 81 children who died on study, 23 (28%) had abnormal lab results:  11% of those with only persistent proteinuria died, and 12% of those with persistent proteinuria, ↑Cr, and ↓GFR died. Only 3.5% of the children with no persistent abnormal lab results died.

Conclusions:  Of these 2103 HIV-infected children with repeated lab tests, 6% carried renal diagnoses and 22% had persistently abnormal lab results; 25% had either diagnoses or lab indications of renal disease. ↑Cr occurred twice as frequently as persistent proteinuria and abnormal lab results other than persistent proteinuria preceded persistent proteinuria in 19% of cases. Of those who died while on study, 28% had persistent abnormal lab results. Renal pathology in HIV⁺ children is a common complication associated with both HIV-related morbidity and mortality.