ESPN 51th Annual Meeting

ESPN 2018


 
Prevalence of albuminuria and the association with APOL1 risk variants (G1 and G2) in HIV infected children from Central Africa (Democratic Republic of Congo)
Pepe EKULU MFUTU 1 Dieumerci Betukumesu 2 Agathe NKOY BIKUPE 2 Michel ALONI NTETANI 2 Fran├žois LEPIRA BOMPEKA 3 Lambert VAN DEN HEUVEL 1 Elena LEVTCHENKO 1

1- Department of Paediatric Nephrology & Development and Regeneration, University Hospitals Leuven KU Leuven - University of Leuven, Leuven, Belgium
2- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo
3- Division of Nephrology, Department of Internal Medicine, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo
 
Introduction:

The increased risk of progressive chronic kidney disease (CKD) including HIV-related CKD among sub-Saharan African descents has been attributed to apolipoprotein-L1 (APOL1) genetic variants G1 and G2. However, in sub-Saharan Africa, region where HIV infection and its complications are a substantial healthcare problem, the geographical distribution of APOL1 risk variants and the association with HIV-related CKD are not yet well documented, and there is no reliable data from the Democratic Republic of Congo (DRC).

 

Objectives:

We aimed to describe the prevalence of albuminuria (an early marker of CKD) and to assess the association between the early kidney damage and the APOL1 risk variants in both treated HIV infected children and apparently healthy children.

Material and methods:

A total of 813 participants, of whom 401 HIV infected children treated with retroviral drugs and 412 apparently healthy children, were enrolled from four large districts in Kinshasa, the capital of the DRC. APOL1 high-risk genotype was defined by the presence of 2 risk variants (G1/G1, G2/G2, and G1/G2) and low risk genotype if 0 or 1 risk variants were present. Albumin-to-creatinine ratio (ACR), as an early marker of CKD, was assessed in a fresh morning urine sample in both HIV infected children and controls. The elevated ACR was defined as ACR>30mg/g.

Results:

From 813 children recruited, APOL1 sequence analysis revealed 52 (6.4%) participants carrying the high risk genotype. Regarding the low risk genotypes, 168 (20.6%) participants carried G1/G0 while 116 (14%) carried G2/G0. Of 401 HIV infected children, 72(18%) had elevated ACR versus 40 (9.7%) out of 412 apparently healthy children (OR 2.04, 95% CI 1.32-3.16; p<0.001). Considering the prevalence of elevated ACR in relation to the presence of APOL1 high risk genotype, out of 23 HIV infected children carrying the high risk genotype, 18 (78.3%) had elevated ACR while 5 out of 29 (17.2%) apparently healthy children had elevated ACR (p<0.001).

Conclusions:

The burden of APOL1 risk variants is high in the DRC. The HIV infection is strongly associated with the presence of renal disease in children, especially in those carrying the APOL1 high risk genotype.