ABSTRACT
BACKGROUND: This study describes the incidence, clinical and demographic characteristics, and spectrum of chronic kidney disease (CKD) in youths with perinatal HIV-1 infection. METHODS: Retrospective analysis between May 1993 and December 2006 of subjects with renal disease followed in the Pediatric AIDS Clinical Trials Group 219/219C multicenter study examining the long-term consequences of perinatal HIV infection. Diagnosis confirmation was made utilizing a questionnaire mailed to research sites. Participants with CKD of other etiology than HIV were excluded. Outcome measures were biopsy-diagnosed CKD and, in the absence of biopsy, HIV-associated nephropathy (HIVAN) using established clinical criteria. RESULTS: Questionnaires on 191 out of 2,102 participants identified 27 cases of CKD: 14 biopsy-diagnosed and 6 clinical cases of HIVAN, and 7 biopsy-diagnosed cases of immune complex-mediated kidney disease (lupus-like nephritis, 3; IgA nephropathy, 2; membranous nephropathy, 2). Incidence rates for CKD associated with HIV in pre-highly active antiretroviral therapy (HAART) (1993-1997) and HAART (1998-2002, 2003-2006) eras were 0.43, 2.84, and 2.79 events per 1,000 person years respectively. In multivariate analysis, black race and viral load ≥100,000 copies/mL (rate ratios 3.28 and 5.05, p ≤ 0.02) were associated with CKD. CONCLUSIONS: A variety of immune complex-mediated glomerulonephritides and HIVAN occurs in this population. Black race and uncontrolled viral replication are risk factors for CKD associated with HIV.
Subject(s)
AIDS-Associated Nephropathy/epidemiology , Glomerulonephritis/epidemiology , HIV Infections/epidemiology , HIV-1/pathogenicity , AIDS-Associated Nephropathy/diagnosis , AIDS-Associated Nephropathy/immunology , AIDS-Associated Nephropathy/virology , Adolescent , Black or African American/statistics & numerical data , Age Factors , Biopsy , CD4 Lymphocyte Count , Chi-Square Distribution , Child , Child, Preschool , Chronic Disease , Female , Glomerulonephritis/diagnosis , Glomerulonephritis/immunology , Glomerulonephritis/virology , HIV Infections/diagnosis , HIV Infections/immunology , HIV Infections/virology , HIV-1/growth & development , Humans , Incidence , Infant , Infant, Newborn , Linear Models , Male , Multicenter Studies as Topic , Multivariate Analysis , Puerto Rico/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Surveys and Questionnaires , Time Factors , United States/epidemiology , Viral Load , Virus ReplicationABSTRACT
OBJECTIVE: To determine rate of and risk factors for birth defects in infants born to HIV-infected women receiving nucleoside and protease inhibitor antiretroviral (ARV) therapy. METHODS: Birth defects were evaluated among infants on the Pediatric AIDS Clinical Trials Group 316 trial that studied addition of peripartum nevirapine to established ARV regimen for prevention of mother-to-child transmission. Maternal therapy was categorized by trimester of earliest exposure. Birth defects were coded using conventions of the Antiretroviral Pregnancy Registry. RESULTS: Birth defects were detected in 60/1414 (4.2%; 95% CI 3.3-5.4%) infants including 30/636 (4.7%; 95% CI 3.2-6.7%) with first trimester ARV exposure and 30/778 (3.9%; 95% CI 2.6-5.5%) with exposure only after the first trimester (P=0.51). Rates of classes of defects were similar between first trimester compared to later exposure groups except heart defects which occurred in 16 (2.5%; 95% CI 1.4-4.1%) with first trimester ARV exposure and in six (0.8%; 95% CI 0.3-1.7%) infants with later exposure (P=0.02). Exposure to ARV was not associated with specific types of heart defects. Two cases of cardiomyopathy were noted. CONCLUSION: ARV use in early pregnancy was not associated with an increased risk of birth defects overall. The possible association of ARV exposure with heart defects requires further surveillance.
Subject(s)
Anti-HIV Agents/adverse effects , Congenital Abnormalities/etiology , HIV Infections/complications , HIV Infections/drug therapy , Pregnancy Complications, Infectious/drug therapy , Adult , Cohort Studies , Congenital Abnormalities/epidemiology , Double-Blind Method , Female , HIV Infections/transmission , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/etiology , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Nevirapine/adverse effects , Pregnancy , Risk FactorsABSTRACT
Human immunodeficiency virus-infected women (n=16) received indinavir (800 mg three times a day) plus zidovudine plus lamivudine from 14 to 28 weeks of gestation to 12 weeks postpartum. Two women and eight infants experienced grade 3 or 4 toxicities that were possibly treatment related. Indinavir area under the plasma concentration-time curve was 68% lower antepartum versus postpartum, suggesting increased intestinal and/or hepatic CYP3A activity during pregnancy.