1 - Infectious Diseases Unit, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central
2 - Pediatric Nephrology Department, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central
3 - Pediatrics, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central
- 38th Annual Meeting of the European Society for Paediatric Infectious Diseases
- Poster
Resumo:
Background: Children with Human immunodeficiency virus-associated nephropathy (HIVAN) may present with the classical features of nephrotic syndrome or with isolated and persistent proteinuria. The renal histological lesions are typically characterized by evidence of focal and segmental collapsing glomerulosclerosis and microcystic tubular dilatation. The exact prevalence of HIVAN in children is unknown as the definitive diagnosis requires renal biopsy, which is not routinely performed. The aim of the present study is to characterise the population of a tertiary hospital with respect to the diagnosis of HIVAN.
Methods: Cross-sectional descriptive study of HIV-infected children, followed in immunodeficiency appointments between January and December 2019 (12 months), with the diagnosis of HIVAN.
Results: We report 4 cases of HIVAN (5.3%), all in HIV-1 infected children of African ancestry. Average age at diagnosis of 3 years (SD1). Clinical and immunological categories B1 (n=2), B2 (n=1), B3 (n=1). HIV load exceeded 400copies/mL in 2 patients and CD4 cell count nadir was lower than 30/mL in 1 child. 2 patients had already begun anti-retroviral therapy, with poor compliance. All had significant proteinuria (urine protein/creatinine ratio within 0.22-1.70), with normal kidney function. No history of diabetes, hypertension, acute kidney injury or exposure to other nephrotoxic drugs registered.
Conclusions: Effective anti-retroviral therapy is associated with a marked improvement of HIVAN and its early use may prevent progression to end-stage renal disease. Proteinuria and renal function should therefore be routinely monitored. In the study population, monitoring seems to be of particular relevance in children of African ancestry and children with low adherence to anti-retroviral therapy.
Palavras Chave: human immunodeficiency virus, nephropathy