HAART may slow proteinuria progression in HIV-infected children
By Will Boggs, MD
NEW YORK (Reuters Health) Jun 26 - Renal disease that affected a third of HIV-infected children in one study was slowed by control of viral load with highly active antiretroviral therapy (HAART), according to a report in the June issue of The Journal of Pediatrics.
"Proteinuria in HIV infected patients is a common manifestation of disease activity and should be a 'red flag' for disease activity - especially in children," Dr. Carolyn L. Abitbol from the University of Miami, Florida told Reuters Health.
She and her colleagues studied 286 children infected with HIV-1, analyzing the prevalence of proteinuria as well as associated risk factors and outcome relative to their HIV-1 RNA viral load. One third of the children had persistent proteinuria at baseline, including 32 (11.2%) with nephrotic-range proteinuria.
Viral load was highest in patients with nephrotic-range proteinuria, intermediate in those with persistent proteinuria, and lowest in patients without proteinuria, the report indicates. The correlation between viral load and proteinuria was particularly strong in patients receiving HAART.
Children with proteinuria in the nephrotic range had significantly lower absolute CD4 counts and a significantly higher prevalence of CDC category 3 disease/AIDS.
In half the patients in the initial nephrotic-range group and in 63% of those with persistent proteinuria at baseline, renal function normalized and proteinuria improved or resolved in conjunction with a decrease in viral load during mean follow-up of 5.6 years, the investigators say.
Increasing proteinuria was associated with decreasing survival, the report indicates.
"Proteinuria may occur in as much as one third of the population, but the nephropathy per se, defined as nephrotic-range proteinuria, is probably no more than 10% and may be clinically benefited by HAART or angiotensin blockade therapy," the authors conclude.
"Those patients within the nephrotic range of proteinuria (urine protein/creatinine >1.0) are obviously at greatest risk," Dr. Abitbol said. "We make a concerted effort to get compliance with HAART and get the viral load down. We also use ACE/ARB therapy in combination if the blood pressure allows."
"A renal biopsy is also very much warranted to make a definitive diagnosis - since there is truly a spectrum of renal pathologies in this patient group," Dr. Abitbol added.
J Pediatr 2008;152:844-849.
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