Prevalence and factors associated with renal dysfunction in HIV positive paediatric patients in highly active antiretroviral therapy at the Centre of excellence of the University Teaching Hospital, in Lusaka, Zambia

Abstract

Background- Although sub-Saharan Africa has the largest number of children living with the Human Immunodeficiency Virus (HIV), little is known about the prevalence of HIV related kidney disease in these children despite the recognition of HIV infection as a strong risk factor for kidney disease [1,2]. This study investigated the prevalence and factors associated with renal dysfunction in HIV positive paediatric patients on highly active antiretroviral therapy at the Paediatric Centre of Excellence (PCOE) of the University Teaching Hospital (UTH), Lusaka, Zambia. Methodology- The study was a cross sectional survey conducted at the PCOE of the UTH in Lusaka, Zambia. Enrolment of all eligible participants was from April to September, 2014. The Inclusion criteria were patients aged 18 months to 16 years who consented or and assented to the study and were on HAART. Renal dysfunction was defined as at least abnormal renal laboratory values in at least 1 of 3 measures of proteinuria, serum creatinine or Estimated Glomerular Filtration Rate (eGFR) 60mL/min/1.73m2 for the age and height-adjusted value as defined by The Kidney Improving Global Outcomes (KDIGO) 2012 on two occasions. A file review and clinical evaluation was done by the study physician to determine the factors associated with renal dysfunction. Bloods were drawn for CD4 count, Haemoglobin (HB), Creatinine and Urine was taken for dipstick urinalysis. Results- Of the 209 participants enrolled in this cross sectional study, 105(50.2%) were females. This study found a prevalence of 8.1% (CI=5.0-12.5), of renal dysfunction among paediatric HIV patients followed up at PCOE. Children aged 13 and above had on average 23 times greater odds for renal dysfunction [adjusted odds ratio (OR) = 23.76, and 95% confidence interval (CI) = (5.30 – 106.53), P-value <0.01] compared to children under 13 years old. Children receiving nephrotoxic HAART had on average 6 times greater odds for renal dysfunction [OR=5.55, CI= (1.57 – 19.65), P-value = 0.01] compared to children receiving Non-Nephrotoxic HAART. Conclusion- The prevalence of renal dysfunction among paediatric HIV infected patients followed up at the PCOE at UTH in Lusaka Zambia is 8.1%, at 95% CI= (5.0-12.5) and associated factors include increase in age and nephrotoxic HAART. Key words- Renal Dysfunction, Paediatric HIV patients, Proteinuria, Serum Creatinine, Estimated Glomerular Filtration Rate, Highly Active Antiretroviral Therapy (HAART)