Impact of antiretroviral therapy on renal function among HIV-infected tanzanian adults: A retrospective cohort study
Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania; Department of Medicine, Weill Cornell Medical College, New York, NY, United States; Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
Background: Data regarding the outcomes of HIV-infected adults with baseline renal dysfunction who start antiretroviral therapy are conflicting. Methods: We followed up a previously-published cohort of HIV-infected adult outpatients in northwest Tanzania who had high prevalence of renal dysfunction at the time of starting antiretroviral therapy (between November 2009 and February 2010). Patients had serum creatinine, proteinuria, microalbuminuria, and CD4+ T-cell count measured at the time of antiretroviral therapy initiation and at follow-up. We used the adjusted Cockroft-Gault equation to calculate estimated glomerular filtration rates (eGFRs). Results: In this cohort of 171 adults who had taken antiretroviral therapy for a median of two years, the prevalence of renal dysfunction (eGFR <90 mL/min/1.73 m2) decreased from 131/171 (76.6%) at the time of ART initiation to 50/171 (29.2%) at the time of follow-up (p<0.001). Moderate dysfunction (eGFR<60 mL/min/1.73 m2) decreased from 21.1% at antiretroviral therapy initiation to 1.1% at follow-up (p<0.001), as did the prevalence of microalbuminuria (72% to 44%, p<0.001). Use of tenofovir was not associated with renal dysfunction at follow-up. Conclusion: Mild and moderate renal dysfunction were common in this cohort of HIV-infected adults initiating antiretroviral therapy, and both significantly improved after a median follow-up time of 2 years. Our work supports the renal safety of antiretroviral therapy in African adults with mild-moderate renal dysfunction, suggesting that these regimens do not lead to renal damage in the majority of patients and that they may even improve renal function in patients with mild to moderate renal dysfunction. © 2014 Mpondo et al.
antiretrovirus agent; creatinine; efavirenz plus emtricitabine plus tenofovir disoproxil; efavirenz plus lamivudine plus zidovudine; lamivudine plus nevirapine plus stavudine; lamivudine plus nevirapine plus zidovudine; adult; article; CD4+ T lymphocyte; cohort analysis; creatinine blood level; female; follow up; glomerulus filtration rate; human; Human immunodeficiency virus infection; kidney dysfunction; kidney function; major clinical study; male; microalbuminuria; outcome assessment; outpatient; prevalence; proteinuria; retrospective study; Tanzania; chemically induced; complication; drug effects; highly active antiretroviral therapy; HIV Infections; Human immunodeficiency virus; kidney function test; mortality; pathogenicity; prognosis; Renal Insufficiency; risk factor; survival rate; Adult; Antiretroviral Therapy, Highly Active; Female; Follow-Up Studies; Glomerular Filtration Rate; HIV; HIV Infections; Humans; Kidney Function Tests; Male; Prevalence; Prognosis; Renal Insufficiency; Retrospective Studies; Risk Factors; Survival Rate; Tanzania