Predictors of resolution and persistence of renal laboratory abnormalities in pediatric HIV infection

Charles D. Mitchell, Miriam C. Chernoff, George R. Seage, Murli U. Purswani, Hans M.L. Spiegel, Gaston Zilleruelo, Carolyn Abitbol, Barbara Heckman, Christopher B. Ponce, James M. Oleske

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background Among human immunodeficiency virus (HIV)-infected youth, the role of renal disease (RD) and its management has become increasingly important as these children/adolescents mature into young adults. The identification of predictors of abnormal renal laboratory events (RLE) may be helpful in the management of their HIV infection and its associated renal complications. Methods Data collected from HIV-infected youth followed for ≥ 48 months were analyzed to identify predictors of resolution versus persistence of RLE and determine the utility of RLE to predict the onset of RD. Analysis included descriptive and inferential methods using a multivariable extended Cox proportional hazards model. Results Of the 1,874 at-risk children enrolled in the study, 428 (23 %) developed RLE, which persisted in 229 of these (54 %). CD4 percentages of <25 % [hazard ratio (HR) 0.63, p < 0.002) and an HIV viral load of >100,000 copies/ml (HR 0.31, p < 0.01) were associated with reduced rates of resolution, while in most cases exposure to highly active antiretroviral therapy (HAART)/nephrotoxic HAART prior to or subsequent to RLE were not. Persistence of RLE was 88 % sensitive for identifying new RD. Negative predictive values for RD were >95 % for both the at-risk cohort and those with RLE. Conclusions Advanced HIV disease predicted persistence of RLE in HIV-infected youth. Persistent RLE were useful for identifying RD.

Original languageEnglish (US)
Pages (from-to)153-165
Number of pages13
JournalPediatric Nephrology
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • HAART
  • HIV
  • HIV renal disease
  • Pediatric
  • Perinatal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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    Mitchell, C. D., Chernoff, M. C., Seage, G. R., Purswani, M. U., Spiegel, H. M. L., Zilleruelo, G., Abitbol, C., Heckman, B., Ponce, C. B., & Oleske, J. M. (2015). Predictors of resolution and persistence of renal laboratory abnormalities in pediatric HIV infection. Pediatric Nephrology, 30(1), 153-165. https://doi.org/10.1007/s00467-014-2909-1