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Renal Dysfunction Among HIV-Infected Patients Starting Antiretroviral Therapy.

Msango, L., Downs, J. A., Kalluvya, S. E., Kidenya, B. R., Kabangila, R., Johnson, W. D., Fitzgerald, D. W. and Peck, R. N. (2011) Renal Dysfunction Among HIV-Infected Patients Starting Antiretroviral Therapy. AIDS (London, England), 25 (11). ISSN 1473-5571

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Abstract

HIV-related renal dysfunction is associated with high mortality. Data on the prevalence of renal dysfunction among HIV-infected outpatients starting antiretroviral therapy (ART) in sub-Saharan Africa are limited. Recent recommendations to include the nephrotoxic drug tenofovir in first-line ART regimens make clarification of this issue urgent. We screened for renal dysfunction by measuring serum creatinine, proteinuria, and microalbuminuria in HIV-positive outpatients initiating ART in Mwanza, Tanzania. We excluded patients with pre-existing renal disease, hypertension, diabetes, or hepatitis C virus co-infection. Estimated glomerular filtration rates (eGFRs) were calculated by Cockroft-Gault and Modification of Diet in Renal Disease equations. Only 129 (36%) of 355 enrolled patients had normal eGFRs (grade 0 or 1) above 90 ml/min per 1.73 m. Grade 2 renal dysfunction (eGFR between 60 and 89 ml/min per 1.73 m) was present in 137 patients (38.6%), and 87 patients (25%) had grade 3 dysfunction (eGFR between 30 and 59 ml/min per 1.73 m). Microalbuminuria and proteinuria were detected in 72 and 36% of patients, respectively. Factors predictive of renal dysfunction in multivariate analysis included female sex [odds ratio (OR) 3.0, 95% confidence interval (1.8-5.1), P < 0.0001], BMI less than 18.5 [OR 2.3 (1.3-4.1), P = 0.004], CD4 T-cell count below 200 cells/μl [OR 2.3 (1.1-4.8), P = 0.04], and WHO clinical stage II or above [OR 1.6 (1.2-2.3), P = 0.001]. Renal dysfunction was highly prevalent in this population of HIV-positive outpatients initiating first ART in Tanzania. This highlights the critical and underappreciated need to monitor renal function in HIV-positive patients in sub-Saharan Africa, particularly given the increasing use of tenofovir in first-line ART.

Item Type: Article
Keywords: Renal Dysfunction, HIV, Antiretroviral Therapy, Sub-Saharan Africa
Subjects: HIV > Prevention
HIV > Treatment
Divisions: Catholic University of Health and Allied Sciences (CUHAS)
Depositing User: Mr Joseph Madata
Date Deposited: 13 May 2013 06:30
Last Modified: 13 May 2013 06:30
URI: http://ihi.eprints.org/id/eprint/1387

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