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BackgroundMore than two-thirds of the world's HIV-positive individuals live in sub-Saharan Africa, where genetic susceptibility to kidney disease is high and resources for kidney disease screening and antiretroviral therapy (ART) toxicity monitoring are limited. Equations to estimate glomerular filtration rate (GFR) from serum creatinine were derived in Western populations and may be less accurate in this population.MethodsWe compared results from published GFR estimating equations with a direct measure of GFR by iohexol clearance in 99 HIV-infected, ART-naïve Kenyan adults. Iohexol concentration was measured from dried blood spots on filter paper. The bias ratio (mean of the ratio of estimated to measured GFR) and accuracy (percentage of estimates within 30% of the measured GFR) were calculated.ResultsThe median age was 35 years, and 60% were women. The majority had asymptomatic HIV, with median CD4+ cell count of 355 cells/mm3. Median measured GFR was 115 mL/min/1.73 m2. Overall accuracy was highest for the Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equation. Consistent with a prior report, bias and accuracy were improved by eliminating the coefficient for black race (85% of estimates within 30% of measured GFR). Accuracy of all equations was poor in participants with GFR 60–90 mL/min/1.73 m2 (<65% of estimates within 30% of measured GFR), although this subgroup was too small to reach definitive conclusions.ConclusionsOverall accuracy was highest for the CKD-EPI equation. Eliminating the coefficient for race further improved performance. Future studies are needed to determine the most accurate GFR estimate for use in individuals with GFR <90 mL/min/1.73 m2, in whom accurate estimation of kidney function is important to guide drug dosing. Direct measurement of GFR by iohexol clearance using a filter paper based assay is feasible for research purposes in resource-limited settings, and could be used to develop more accurate GFR estimates in African populations.

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that can mimic early symptoms of TB; 2,5,6 the nature of pulmonary TB (PTB) disease in HIV-infected people, which often renders sputum smear microscopy (the most commonly available diagnostic tool in resourcelimited settings) negative; 7 and the fear of use of chest radiography (CXR) in pregnancy due to concerns regarding radiation-induced teratogenicity. 5 Symptom screening is recommended to identify TB suspects in HIV-infected populations, 8 including pregnant women, 9 but it has not been evaluated in HIVi nfected pregnant women. The study populations of the two most recent published studies, Cain et al. and Corbett et al., were composed of HIV-infected adult patients but were not stratifi ed with regard to pregnancy status. 10,11 Similarly, in a meta-analysis of observational studies there was no stratifi cation based on pregnancy status. 8 As such these results may not be applicable to the HIV-infected pregnant population. In a PMTCT program in western Kenya, access to clinical laboratory services and CXR allowed for in-depth investigations into the role of symptom screening in HIV-infected pregnant women.The aim of this study was to determine the diagnostic usefulness of symptom screening for TB in detecting active PTB among HIV-infected pregnant women in two PMTCT clinics in western Kenya. This was a descriptive analysis of women who were positive or negative on symptom screening to compare demographics, sputum results, CXR results and TB diagnosis. METHODS Study designThis was a cross-sectional analysis of data. SettingThe study was carried out in two Government of K enya PMTCT clinics, Eldoret and Busia in western Kenya, which are supported by the Academic Model Providing Access to Healthcare (AMPATH) partnership. [12][13][14] These two sites were chosen because they represented the busiest PMTCT programs in AMPATH (on average 30 patients each per month), both had access to a quality-controlled TB laboratory, were capable of smear microscopy and rapid culture (Mycobacteria Growth Indicator Tube), and both sites had functional CXR, with appropriate shielding for pregnant women. This study took place between 1 October 2009 and 28 February 2010. Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor Objective: To determine the diagnostic usefulness of tuberculosis (TB) symptom screening to detect active pulmonary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for International Development-Academic Model Providing Access to Healthcare partnership. Design: Cross-sectional study. Participants were interviewed for TB symptoms with a standardized questionnaire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted sputum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gestation underwent shielded chest radiography (CXR).Results: Of 187...