Proteinuria in HIV-Infected Children: Prevalence and Associated Risk Factors

Background: Renal abnormalities are increasingly recognised among children living with human immunodeficiency virus, even after the initiation of antiretroviral therapy. Proteinuria may be an early marker of HIV-related kidney injury and may develop before a measurable reduction in renal function. The aim is to determine the prevalence of proteinuria and identify associated clinical, immunological and treatment-related factors among children living with HIV. Material and Methods: This hospital-based cross-sectional study included 161 HIV-infected children aged 18 months to 16 years attending the Antiretroviral Therapy Clinic at the Indira Gandhi Institute of Child Health, Bengaluru, from January 2021 to July 2022. Demographic, clinical, immunological, virological and treatment-related data were collected. Results: The mean age was 12.2 years, and 54% of participants were female. Initial dipstick proteinuria was detected in 13 children (8.1%), while uPCR-defined proteinuria was present in 40 children (24.8%). Persistent dipstick proteinuria was identified in eight children (5.0%), whereas persistent uPCR-defined proteinuria was present in 19 children (11.8%). Advanced clinical stage at the time of study was significantly associated with initial proteinuria (P=0.00069). Conclusion: Proteinuria was common among children living with HIV and was detected more frequently by uPCR than by dipstick testing. Routine quantitative urine protein assessment and periodic renal-function monitoring are recommended, particularly for children with advanced HIV disease or prolonged tenofovir exposure.

Keywords: HIV; children; proteinuria; urine protein-to-creatinine ratio; antiretroviral therapy; tenofovir; renal dysfunction.