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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 1024-1025
Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy


Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

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Date of Web Publication12-Sep-2013
 

How to cite this article:
Al-Mendalawi MD. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy. Saudi J Kidney Dis Transpl 2013;24:1024-5

How to cite this URL:
Al-Mendalawi MD. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Dec 14];24:1024-5. Available from: http://www.sjkdt.org/text.asp?2013/24/5/1024/118085
To the Editor,

I have two comments on the interesting article published by Iduoriyekemwen et al. [1] on the prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus (HIV) and on highly active anti-retroviral therapy (HAART).

Firstly, Iduoriyekemwen et al. [1] stated in their methodology that renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or presence of micro-albuminuria (MA) of ≥20 mg and/or glomerular filtration rate (GFR) <60 mL/min/1.73 m2 . It is well known that HIV-associated nephropathy (HIVAN) manifests commonly as proteinuria, which is preceded by MA. MA is considered as a sensitive marker of the early manifestation of HIV AN. However, this marker might not be adequately sensitive in Nigerian children with HIV AN. In a recent Nigerian study, a total of 154 HIV-positive children aged 18 months to 14 years and 154 HIV-negative children of corresponding attributes were screened for MA using a Micral test II strip, which has a sensitivity of 90-99%. The study revealed that no child among the groups (HIV-positive and -negative) had MA. [2] On the other hand, as control of viral load with HAART was found to decrease MA and prevent the progression of HIV AN in many clinical studies worldwide, [3] - [6] regular determination of MA is widely adopted in clinical settings to assess the therapeutic effect of HAART on HIVAN. Again, such a beneficial effect of the regular determination of MA is questionable in Nigerian children with HIVAN as MA seemed not to be markedly altered by the prior use of HAART. This is supported by the observation that MA was seen in 11.1% of the HIVAN patients on HAART in the study of Iduoriyekemwen et al., [1] which is comparable to 12% in HIVAN patients not receiving HAART reported by Eke et al. [7] It is therefore concluded that MA is not very common among Nigerian children irrespective of their HIV status and prior HAART, and it cannot be incorporated in the diagnostic algorithm of renal involvement in HIV patients.

Secondly, co-infection with tuberculosis (TB) in Nigerian children with HIV is common. [8] TB significantly contributes to proteinuric renal disease in HIV-infected children and the renal disease improves following TB treatment. [9] Accordingly, data addressed by Iduoriyekemwen et al. [1] must be interpreted with caution as they did not address the obvious TB co-infection with HIV in their exclusion criteria. This point needs to be regarded as an important limitation in their study.

Conflict of Interest : None

 
   References Top

1.Iduoriyekemwen NJ, Sadoh WE, Sadoh AE. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy. Saudi J Kidney Dis Transpl 2013; 24:172-7.  Back to cited text no. 1
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2.Bertilla Uzoma E, Henrietta Uchenna O, Anthony Nnaemeka I, Tagbo O. Screening for Microalbuminuria in HIV-Positive Children in Enugu. Int J Nephrol 2012;2012:805834.  Back to cited text no. 2
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3.Takahashi T, Nakamura T, Kanda T, Iwamoto A. Effect of highly active antiretroviral therapy on renal failure in human immunodeficiency virus-associated nephropathy. Res Commun Mol Pathol Pharmacol 2004;115-116:151-6.  Back to cited text no. 3
[PUBMED]    
4.Lucas GM, Eustace JA, Sozio S, Mentari EK, Appiah KA, Moore RD. Highly active anti-retroviral therapy and the incidence of HIV-1-associated nephropathy: A 12-year cohort study. AIDS 2004;18:541-6.  Back to cited text no. 4
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5.Chaparro AI, Mitchell CD, Abitbol CL, et al. Proteinuria in children infected with the human immunodeficiency virus. Pediatr 2008;152: 844-9.  Back to cited text no. 5
    
6.Ramsuran D, Bhimma R, Ramdial PK, et al. The spectrum of HIV-related nephropathy in children. Pediatr Nephrol 2012;27:821-7.  Back to cited text no. 6
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7.Eke FU, Anochie IC, Okpere AN, et al. Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria. Niger J Med 2010;19:298-301.  Back to cited text no. 7
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8.Okechukwu AA, Okechukwu OI. Clinical correlate of tuberculosis in HIV co-infected children at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria. Niger J Clin Pract 2011;14:206-11.  Back to cited text no. 8
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9.Nourse PJ, Cotton MF, Bates WD. Renal manifestations in children co-infected with HIV and disseminated tuberculosis. Pediatr Nephrol 2010;25:1759-63.  Back to cited text no. 9
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Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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DOI: 10.4103/1319-2442.118085

PMID: 24029278

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