Longitudinal patterns of kidney function in children with HIV: insights from group-based trajectory modeling

Kidney dysfunction is increasingly recognized in children with HIV (CWH). We aimed to identify longitudinal patterns of kidney function in a hospital-based cohort.

We retrospectively analyzed estimated glomerular filtration rate (eGFR) data for up to 12 years after antiretroviral therapy (ART) initiation in CWH (aged ≤18 years) who were under active follow-up. Group-based trajectory modeling (GBTM) was used to identify eGFR trajectories. Model selection was based on Bayesian Information Criterion, log Bayes factor, entropy, significance of polynomial terms, minimum group size (≥5%), and posterior probabilities (≥0.70). Multinomial logistic regression examined associations between trajectory membership and predictors, including age at ART initiation, nutritional status, WHO stage, baseline CD4 percentage, adherence, viral load, and tenofovir use.

Among 202 CWH (63.9% boys), age at ART initiation was 4.1 ± 3.1 years. Three trajectories were identified: static (53.5%), early-decline (34.5%), and late-decline (12.0%). The early-decline group showed a steady reduction in eGFR from early follow-up, while the late-decline group demonstrated an initial rise followed by progressive decline. Proteinuria was more frequent in both decline (adverse) trajectories. Older age at ART initiation independently predicted membership in both adverse trajectories, whereas lower baseline CD4 percentage was associated with the late-decline group. Each year delay in ART initiation increased the relative risk of early- and late-decline trajectories by 30% and 50%, respectively, although the relationship was nonlinear.

Distinct eGFR trajectories highlight heterogeneity in kidney function among CWH. Delayed ART initiation and lower baseline CD4 percentage are associated with adverse kidney function trajectories.