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Kidney disease in children and adolescents with perinatal HIV-1 infection

Rajendra Bhimma1, Murli Udharam Purswani, Udai Kala

  • 1Department of Paediatrics and Child Health, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. bhimma@ukzn.ac.za

Journal of the International AIDS Society
|June 21, 2013
PubMed

Insights

Highly active anti-retroviral therapy (HAART) has improved outcomes for children with HIV-1 kidney disease, particularly HIV-associated nephropathy (HIVAN). However, other kidney issues and drug toxicities require ongoing attention and research.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • HIV/AIDS Research

Background:

  • Children with perinatal HIV-1 infection face diverse kidney issues, including acute kidney injury, UTIs, electrolyte imbalances, nephrotoxicity, and glomerular diseases.
  • HIV-associated nephropathy (HIVAN) was a common cause of chronic kidney disease (CKD) in these children, often leading to end-stage kidney disease.

Purpose of the Study:

  • To review the pathogenesis, genetics, clinical presentation, and management of kidney diseases in children and adolescents with perinatal HIV-1 infection.
  • To highlight the impact of highly active anti-retroviral therapy (HAART) on HIV-associated kidney disease outcomes.
  • To discuss current and future strategies for screening, prevention, and treatment of kidney disease in this population.

Main Methods:

  • Literature review focusing on pathogenesis, genetics, clinical presentation, and management.
  • Analysis of the impact of HAART on HIV-associated nephropathy (HIVAN) and other kidney diseases.
  • Evaluation of renal replacement therapies including hemodialysis, peritoneal dialysis, and kidney transplantation.

Main Results:

  • HAART has significantly reduced HIVAN incidence and improved prognosis, allowing long-term survival.
  • The impact of HAART on other kidney diseases and drug-induced nephrotoxicity is less pronounced.
  • Both hemodialysis and peritoneal dialysis are effective renal replacement therapies, with peritoneal dialysis favored in resource-limited settings.

Conclusions:

  • Understanding the molecular pathogenesis and genetics of HIV-related kidney disease is crucial for improved care.
  • Kidney transplantation is now a viable and effective renal replacement therapy for selected HIV-infected patients.
  • Routine kidney disease screening is recommended for HIV-infected children and adolescents where resources permit.
Abstract

Keywords:
adolescentsanti-retroviral drug toxicitychildrenhuman immunodeficiency viruskidney

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