Prevalence of HIV-associated nephropathy in children: A systematic review with meta-analysis of studies published between 2004 and 2019

Introduction Despite major advances in antiretroviral therapy, HIV infection remains a significant global public health challenge. HIV can directly affect the kidneys, leading to HIV-associated nephropathy in children, a condition characterized by proteinuria, elevated serum creatinine, and kidney enlargement. HIV-associated nephropathy is a serious complication that may progress to kidney failure and death.

Objective To estimate the prevalence of HIV-associated nephropathy in children.

Methods We searched PubMed, Embase, LILACS, SciELO, and Web of Science for relevant studies. Searches used the
terms “AIDS-associated nephropathy” AND “child.”

Results A total of 1,181 records were identified, of which 10 studies (n = 1,136 children living with HIV) met inclusion
criteria. Most included studies were conducted before widespread ART availability and used proteinuria as a proxy for
HIV-associated nephropathy. The pooled prevalence of HIV-associated nephropathy was 17% (95% CI, 8%–31%; I2 = 93%,
p < 0.01). Subgroup analysis showed marked geographic variation, with a prevalence of 29% (95% CI, 22%–38%) in Africa
and 8% (95% CI, 3%–20%) in North America. By sex, 59% (95% CI, 49%–69%) of male children developed HIV-associated
nephropathy compared with 41% (95% CI, 31%–51%) of female children. Boys were significantly more likely to develop
HIV-associated nephropathy (p = 0.02). The mortality rate among affected children was 53% (95% CI, 40%–56%). Key risk
factors included lack of antiretroviral therapy and the presence of AIDS.

Conclusion HIV-associated nephropathy was historically a common and life-threatening complication among children living
with HIV. However, the available evidence is largely based on studies conducted more than a decade ago and often relied
on proteinuria rather than biopsy-confirmed diagnosis.

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Children or Youth (less than 18 years old)
  • General HIV+ population
• Co-morbidities
  • Other