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Prevalence of Proteinuria and Elevated Serum Cystatin C among HIV-Infected Adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) Study

Aaron, Kristal J. MSPH*,†; Kempf, Mirjam-Colette PhD‡,§,†; Christenson, Robert H. PhD‖,¶; Wilson, Craig M. MD#,†; Muntner, Paul PhD#,*,†; Shrestha, Sadeep PhD, MHS, MS#,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1st, 2012 - Volume 61 - Issue 4 - p 499–506
doi: 10.1097/QAI.0b013e31826d7421
Epidemiology and Prevention

Objective: In the United States, kidney dysfunction is prevalent in almost 30% of HIV-infected patients and is an independent predictor of mortality. Proteinuria and elevated serum cystatin C (eCysC) are used as markers of kidney disease in the general population; however, the prevalence of these markers in HIV-infected adolescents is largely unknown.

Methods: This study includes 304 HIV-infected adolescents from the Reaching for Excellence in Adolescent Care and Health (REACH) cohort, an observational study of adolescents recruited from 13 US cities. Clinical and demographic characteristics of participants were evaluated as correlates of proteinuria, a urine protein to creatinine ratio of ≥200 mg/g. Select univariate predictors were assessed to determine the association with urinary protein excretion and serum cystatin C in multivariable linear regression models and proteinuria and eCysC (eCysC ≥ 75th percentile) in multivariable logistic regression models.

Results: Overall, 19.1% of the participants had proteinuria, whereas 23.7% had an eCysC. Low CD4+ T-lymphocyte counts (<200 cells/mm3) were significantly associated with a greater urine protein to creatinine ratio in linear models and with proteinuria in logistic regression models. CD4+ T-lymphocyte counts <500 cells/mm3 were significantly associated with a greater serum cystatin C concentration in linear models and with eCysC in logistic regression models.

Conclusions: Proteinuria among HIV-infected adolescents in the REACH cohort was approximately 2-fold greater than healthy US adolescents. Both proteinuria and eCysC are associated with CD4+ T-lymphocyte counts. Further studies investigating early markers of kidney disease and the association with immune status and inflammation in HIV-infected adolescents are needed.

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*Nephrology Research and Training Center, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL

University of Alabama at Birmingham, Birmingham, AL

Department of Health Behavior, School of Public Health

§Department of Family/Child Health & Caregiving, School of Nursing

Departments of Pathology and

Medical and Research Technology, University of Maryland School of Medicine, Baltimore, MD

#Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.

Correspondence to: Sadeep Shrestha, PhD, MHS, MS, Department of Epidemiology, R217, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35294-0022 (e-mail:

The REACH study (1994–2001) was supported by the National Institute of Child Health and Human Development (U01-HD32830), with supplemental funding from the NIAID, the National Institute on Drug Abuse, and the National Institute of Mental Health. This work was also supported in part by the Adolescent Trials Network for HIV/AIDS Interventions (ATN) which is funded by the National Institutes of Health through NICHD (5 U01 HD040533).

Presented in part at the 19th Conference on Retroviruses and Opportunistic Infections (CROI) meeting, March 5–8, 2012, Seattle, WA.

The authors have no conflict of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received April 27, 2012

Accepted August 2, 2012

© 2012 Lippincott Williams & Wilkins, Inc.