Chronic kidney disease among children living with the human immunodeficiency virus in sub-Saharan Africa

Abstract

Background: Chronic kidney disease (CKD) remains an important comorbid condition in people living with HIV. However, data in children living with HIV/AIDS (CLWHA) in sub-Saharan Africa is limited. We sought to establish the prevalence and identify risk factors of CKD among CLWHA in SSA. Methods: This was a retrospective chart review across five SSA countries HIV/AIDS care sites, March 2000 and June 2016. Results: 4,859 children with at least two clinic visits were enrolled in the study. The median age at the first clinic visit was 5.7 (IQR; 2.5, 9.5) years, and median follow-up time was 22.6 (IQR 9.8, 46.1) months. 11.2% CLWHA had an eGFR of <60 mL/min/1.73m2 on at least one clinic visit. The prevalence of CKD was 1.6%. In a multivariable Poisson regression analysis, CKD was associated with severe immunosuppression, incident rate ratio (IRR) 2.69 (95% CI, 1.11, 6.51). Risk of CKD decreased with increasing age (IRR 0.51 (95% CI, 0.39, 0.67). There was no association between CKD and ART regimen. Conclusion: CKD was not as prevalent as previously reported in children in other studies. Kidney function monitoring should be incorporated into the pediatric HIV care monitoring guidelines to allow for better evaluation of kidney disease in CLWHA.

Keywords

• Chronic kidney disease
• HIV-infection
• Pediatric HIV
• Sub-Saharan Africa