Prevalence of HIV-associated nephropathy in children: a systematic review with meta-analysis of studies published between 2004 and 2019.
Diogo Costa Garção, João Gabriel Santana Trindade, Susan Soares de Carvalho
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In 30 seconds
This systematic review and meta-analysis estimated the prevalence of HIV-associated nephropathy among children living with HIV. Ten studies including 1,136 children met the inclusion criteria; most were conducted before widespread antiretroviral therapy (ART) availability and often used proteinuria as a proxy diagnosis. The pooled prevalence was 17% (95% CI, 8%-31%; I 2 = 93%, p < 0.01), with substantial geographic variation. The authors characterize the condition as historically common and life-threatening, while noting that the evidence is largely dated and frequently lacks biopsy confirmation.
Key findings
- Pooled prevalence was 17% (95% CI, 8%-31%; I 2 = 93%, p < 0.01) across 10 studies of 1,136 children.
- Prevalence was 29% (95% CI, 22%-38%) in Africa and 8% (95% CI, 3%-20%) in North America.
- Boys were more likely to develop nephropathy than girls (p = 0.02); the reported proportions were 59% (95% CI, 49%-69%) and 41% (95% CI, 31%-51%), respectively.
- Among affected children, the reported mortality rate was 53% (95% CI, 40%-56%).
Why it matters
The review highlights kidney disease as a potentially serious complication of paediatric HIV and reports substantial variation in prevalence across regions. Its findings also underscore the importance of interpreting historical estimates in context: many included studies predated widespread ART and used proteinuria rather than biopsy-confirmed nephropathy, limiting how directly these estimates describe current disease burden.
What to keep in mind
Most studies predated widespread ART, often used proteinuria as a proxy rather than biopsy confirmation, and prevalence estimates showed substantial heterogeneity (I 2 = 93%).