Prevalence and factors associated with renal disease among HIV infected children on antiretroviral therapy attending Joint Clinical Research Center, Lubowa, Kampala

Abstract

Introduction: About 1.8 million children under the age of 15 years are living with HIV globally, 90% of these are in sub-Saharan Africa. In Uganda, 90,000 children between 0 and 14 years are estimated to be living with HIV. Successful clinical outcomes with Antiretroviral Therapy (ART), has improved patients’ survival, thereby paving way for long term diseases like renal complications. The global prevalence of renal disease among PLHIV is 4.8% and in Africa, it is at 7.9%. Renal disease could arise from HIV infection without ART initiation, manifesting as HIV Associated Nephropathy (HIVAN) but with the test and treat policy, the incidence of HIVAN has reduced, it could also arise as a side effect of the commonly used Tenofovir Disoproxil Fumarate (TDF) regimen. Renal disease is asymptomatic in its early stages but on progression into advanced stage is expensive to manage requiring renal replacement therapy. Monitoring of children’s renal functionality is not routinely done but only on a doctor’s request. However, there is currently no published study on renal disease prevalence among children living with HIV in Uganda and the associated factors. Objective: This study aimed at determining the prevalence of renal disease and the associated factors among HIV positive children on ART at the Joint Clinical Research Center (JCRC) Pediatric clinic. Methods: A cross sectional study was conducted from JCRC Pediatrics Clinic. Children attending JCRC Pediatrics clinic between January and August, 2020 were recruited using consecutive sampling. Information on age, sex, weight, height, Body Mass Index (BMI), Blood pressure, route of transmission, clinical stage of the disease, ART regimen, duration on ART, non-ART drugs, Viral load and comorbidities was obtained. Blood and urine samples were also collected from the participants and sent to the laboratory for analysis. Renal disease was diagnosed using proteinuria on urine dipstick and estimated Glomerular Filtration Rate, (eGFR). Results: The study participants were 261, of which 51% were female and 49% male, with a median age of 12 years. The overall prevalence of renal disease was 31.1%; 21.5% with proteinuria and 9.6% with low eGFR. Factors associated with proteinuria were; age (p- value =0.01), clinical stage of the disease (p=0.032) and diastolic blood pressure (DBP, p = 0.001) and with low eGFR were; DBP (p < 0.001) and clinical stage of disease (p < 0.001). Conclusion: The prevalence of proteinuria was high (21.5%) and that of low eGFR was (9.1%). Early screening for renal disease when still asymptomatic as a preventive strategy for renal disease should be considered, especially using affordable yet effective methods like urinalysis.