Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
Pediatr Nephrol. 2019 Feb;34(2):313-318. doi: 10.1007/s00467-018-4080-6. Epub 2018 Sep 15.
Little is known about renal pathology among perinatally HIV-infected children and adolescents in Africa. We assessed the prevalence of risk factors for chronic kidney disease in South African children and adolescents with perinatally acquired HIV-1 (HIV+) on antiretroviral therapy (ART) and HIV-negative children and adolescents.
HIV+ youth aged 9-14 years, on ART for > 6 months and age-matched HIV-negative children and adolescents were eligible for assessment of proteinuria and microalbuminuria using urine dipstick and Vantage analyser method. Blood pressure, estimated glomerular filtration rate, HIV-related variables and metabolic co-morbidities were assessed at enrolment.
Among 620 children and adolescents, 511 were HIV+. The median age was 12.0 years and 50% were female. In HIV+ children and adolescents, 425 (83.2%) had a CD4 count > 500 cells/mm and 391 (76.7%) had an undetectable viral load. The median duration of ART was 7.6 years (IQR 4.6-9.3) with 7 adolescents receiving Tenofovir. The prevalence of any proteinuria, microalbuminuria and hypertension was 6.6%, 8.5% and 13.9%, respectively, with no difference between HIV+ and negative children and adolescents. All participants had a normal glomerular filtration rate. There was no association between metabolic co-morbidities and microalbuminuria.
Proteinuria and microalbuminuria appear to be uncommon in this population. Follow up of those with microalbuminuria may inform long-term outcomes and management of this growing population of HIV+ youth.
在非洲，有关围产期感染艾滋病毒的儿童和青少年的肾脏病理知识甚少。我们评估了在接受抗逆转录病毒治疗（ART）的南非围产期感染艾滋病毒-1（HIV）的儿童和青少年以及 HIV 阴性儿童和青少年中，慢性肾脏病危险因素的流行率。
9-14 岁、接受 ART 治疗>6 个月且年龄匹配的 HIV 阳性青少年以及 HIV 阴性儿童和青少年有资格使用尿液试纸和 Vantage 分析仪方法评估蛋白尿和微量白蛋白尿。在入组时评估血压、估算肾小球滤过率、与 HIV 相关的变量和代谢合并症。
在 620 名儿童和青少年中，有 511 名为 HIV 阳性。中位年龄为 12.0 岁，50%为女性。在 HIV 阳性儿童和青少年中，425 名（83.2%）CD4 计数>500 个细胞/mm，391 名（76.7%）病毒载量不可检测。ART 的中位持续时间为 7.6 年（四分位距 4.6-9.3），有 7 名青少年接受替诺福韦治疗。任何蛋白尿、微量白蛋白尿和高血压的患病率分别为 6.6%、8.5%和 13.9%，HIV 阳性和阴性儿童和青少年之间无差异。所有参与者的肾小球滤过率均正常。代谢合并症与微量白蛋白尿之间无关联。
在该人群中，蛋白尿和微量白蛋白尿似乎并不常见。对微量白蛋白尿患者的随访可能会为这一不断增长的 HIV 阳性青年人群的长期结局和管理提供信息。
