TREATMENT OF HIV ASSOCIATED PROTEINURIA IN HIV-1 INFECTED CHILDREN

Abstract: HIV associated proteinuria is quite rare in children and no cases have been reported from India. We present 2 HIV infected children with HIV associated proteinuria, though not in the nephrotic range who had no proteinuria after treatment with angiotensin converting enzyme (ACE) inhibitor and antiretroviral therapy.

Case 1: A six year old boy presented with bronchopneumonia, meningitis, otitis media and hypertension. He was diagnosed to be HIV infected 3 years back and was started on 2 drug antiretroviral therapy (ART) consisting of Zidovudine (AZT) and Lamivudine (3TC) which parents continued on their own without regular follow up with his physician. Urine examination revealed 3+ albuminuria on more than 3 occasions with urine albumin/creatinine ratio of 1.55. Other renal function tests were normal. In view of persistent proteinuria, he was started on Enalapril to which the albuminuria subsided. His antiretroviral regime was shifted to 3 drugs consisting of Zidovudine, Didanosine and Efavirenz. On follow up, he had a weight gain of 2 kg in 20 days with no albuminuria and normal blood pressure.

Case 2: A 2 year 3-month-old girl presented with HIV infection and Miliary TB. Her urine albumin was 2+ on 3 occasions and urine albumin/creatinine ratio was 1.4. She was treated with 3-drug antiretroviral therapy (ART) consisting of Zidovudine, Lamivudine and Nevirapine and antituberculous therapy. On follow-up, she had no proteinuria and X-ray chest showed clearing of miliary shadows.
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