Prevalence of HIV-associated nephropathy in children: a systematic review with meta-analysis of studies published...

Despite major advances in antiretroviral therapy, HIV infection remains a significant global public health challenge. HIV can directly affect the kidneys, leading to HIV-associated nephropathy in children, a condition characterized by proteinuria, elevated serum creatinine, and kidney enlargement. HIV-associated nephropathy is a serious complication that may progress to kidney failure and death.

To estimate the prevalence of HIV-associated nephropathy in children.

We searched PubMed, Embase, LILACS, SciELO, and Web of Science for relevant studies. Searches used the terms "AIDS-associated nephropathy" AND "child."

A total of 1,181 records were identified, of which 10 studies (n = 1,136 children living with HIV) met inclusion criteria. Most included studies were conducted before widespread ART availability and used proteinuria as a proxy for HIV-associated nephropathy. The pooled prevalence of HIV-associated nephropathy was 17% (95% CI, 8%-31%; I² = 93%, p < 0.01). Subgroup analysis showed marked geographic variation, with a prevalence of 29% (95% CI, 22%-38%) in Africa and 8% (95% CI, 3%-20%) in North America. By sex, 59% (95% CI, 49%-69%) of male children developed HIV-associated nephropathy compared with 41% (95% CI, 31%-51%) of female children. Boys were significantly more likely to develop HIV-associated nephropathy (p = 0.02). The mortality rate among affected children was 53% (95% CI, 40%-56%). Key risk factors included lack of antiretroviral therapy and the presence of AIDS.

HIV-associated nephropathy was historically a common and life-threatening complication among children living with HIV. However, the available evidence is largely based on studies conducted more than a decade ago and often relied on proteinuria rather than biopsy-confirmed diagnosis.