Prevalence of Microalbuminuria and Associated Risk Factors in HIV-Infected Children seen at a Tertiary Health Centre in the Niger Delta Region of Nigeria

Background: Human Immunodeficiency Virus (HIV) infection affects multiple organs, including the kidneys. One of the earliest signs of kidney disease related to HIV is the presence of proteinuria, which is preceded by microalbuminuria (MA). Detecting MA in its early stages and providing appropriate intervention can help slow down or even reverse the progression of kidney disease to end-stage renal disease (ESRD). Surprisingly, routine screening for MA is not yet a standard practice in the care of HIV-infected children.

Aim: This study aimed to assess the prevalence of microalbuminuria and associated factors in children with HIV attending the paediatric infectious disease clinic (PIDC) at the Federal Medical Centre, Yenagoa (FMCY).

Methods and Materials: This was a comparative cross-sectional study conducted over a three-month period (18th October, 2021 to 10th January, 2022), involving 150 subjects, both human immunodeficiency virus infected and uninfected at the PIDC and children outpatient clinic (CHOP) of FMCY. The study involved 150 HIV-infected and 150 uninfected subjects. Subjects with normal urine specific gravity and who tested negative for protein, leukocytes, blood, nitrites, and glucose on urinalysis had their urine assessed for the presence of microalbuminuria using the Micral Test II. Those who tested positive for microalbuminuria had their glomerular filtration rate (GFR) estimated, and a renal ultrasound scan was performed. Bivariate logistic regression analyses was conducted to identify factors associated with microalbuminuria. Factors with statistical significance (P value less than .05) at the bivariate level were included in the multiple logistic regression analysis. The significance level was set at a P value less than .05.

Results: The prevalence of microalbuminuria among human immunodeficiency virus infected subjects (18.7%) was significantly higher than uninfected subjects (2.7%) (P < 0.001). The prevalence of microalbuminuria was significantly higher in human immunodeficiency virus infected subjects aged 11-15 years (P = 0.018), those who had been living with human immunodeficiency virus for over 10 years (P = 0.042), those on a regimen containing tenofovir (P = 0.037), and those with poor adherence to antiretroviral therapy (P = 0.012). Other factors significantly associated with a higher prevalence of microalbuminuria included clinical stage four human immunodeficiency virus disease (P = 0.001), advanced immunosuppression (P = 0.016), and an unsuppressed viral load (P = 0.001). The use of a tenofovir based regimen and having clinical stage four disease were the only predictors of microalbuminuria following multivariate logistic regression (Adjusted OR: 7.87, 95% CI: 1.88 – 70.48, P = 0.045, and OR: 14.71, 95% CI: 1.17 – 185.69, P = 0.038). Six HIV-infected subjects with microalbuminuria had mildly decreased eGFR with mean of 77.3 ± 10.8. Renal length and echogenicity were normal for all subjects with microalbuminuria.

Conclusion: Microalbuminuria was more prevalent in HIV-infected children compared to their uninfected counterparts, with clinical stage four disease being the most significant factor associated with microalbuminuria.