Naicker, Miriam Adhikari and Dr Duran Ramsuran.
UKZN College of Health Science’s researchers have established HIV-related Nephropathy (HIVAN) is high in children aged between one and 16.
The study, recently published in the International Innovation Journal, sought to establish how Highly Active Antiretroviral Therapy (HAART) would impact on these children and what pathogenic components were required to understand HIVAN.
Previous studies have confirmed that up to 30 percent of adults who are HIV+ may have kidney disease and a spectrum of kidney diseases also presents in HIV+ children. This may include electrolyte disorders, tubular functional abnormalities and a range of glomerular associated with proteinuria including full-blown nephrotic syndrome.
Children with HIV-related kidney disease may also develop acute kidney injury, thrombotic microangiopathies (including atypical forms of haemolytic uraemic syndrome) and some may progress to chronic kidney disease. Despite this, a general lack of surveillance and reporting of kidney diseases in HIV-infected children exists in most developing regions of the world where HIV is highly prevalent such as sub-Saharan Africa, which accounts for more than 70 percent of global HIV infections.
UKZN scientists Professor Miriam Adhikari, Professor Rajendra Bhimma, Professor Anita Naicker and Dr Duran Ramsuran sought to address this research gap by conducting the largest study of its kind on 71 HIV+ children presenting with nephropathy as evident by persistent proteinuria and who were eligible for antiretroviral therapy, according to the standard of care utilised by the Department of Health in KwaZulu-Natal.
Adhikari and Bhimma said the objectives of the study were based on their observations in the clinical settings that many older HIV+ children presented with nephropathy. The study included patients being treated at the King Edward VIII and Inkosi Albert Luthuli Central hospitals in Durban. These hospitals are the major referral centres for children with complex renal diseases in the province.
Results of the study demonstrate that in regions where HIV is endemic, the most common presentation is that of nephrotic syndrome with histopathological findings of classical focal segmental glomerulosclerosis (FSGS) on kidney biopsy. The researchers also established that HAART is highly effective in decreasing proteinuria and preserving renal function.
Bhimma said: ‘Therefore, all children presenting with nephrotic syndrome in areas that have a high prevalence of HIV infection should routinely be screened for HIV.’
This study provides the largest database on paediatric HIV-related nephropathy in Africa. The findings have contributed to an enhanced understanding of the molecular pathogenesis and genetics of HIV-Associated Nephrology, which will ultimately result in better prevention and treatment.
Adhikari said: ‘In this study it was shown that the virus persists in the kidney while the viral load in the blood may be negligible. Even if we give antiretroviral therapy, the virus is not “killed”; it simply is removed from the circulation so the viral load is undetectable. The virus may sit in the kidney and other organ sites only to be replicating under certain circumstances. This indicates that we need to find better drugs that eliminate the virus from all organs.’
*Adhikari is a Paediatrician who sub-specialises in neonatology with an interest in paediatric nephrology, while Bhimma is a Paediatrician and a member of both national and international associations committed to improving the health of children with kidney diseases.
Naicker is a Medical Scientist with a focus on cell biology. Ramsuran is a current Postdoctoral student whose research is on establishing an organotypic model of lung and gut mucosa that will allow him to study the infections of both HIV and TB with the immune system at these crucial sites of infection.