Impact of Antiretroviral Therapy on Renal Function among HIV-Infected Tanzanian Adults: A Retrospective Cohort Study

Abstract

BackgroundData regarding the outcomes of HIV-infected adults with baseline renal dysfunction who start antiretroviral therapy are conflicting.MethodsWe 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).ResultsIn 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.ConclusionMild 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.

Assessment of the effect of antiretroviral therapy on renal and liver functions among HIV-infected patients: a retrospective study

“…In this study, stage 3 (eGFR, 30–59.9) was the highest (100% vs. 93.7%) among the CKD patients before and after treatment, but the results of previous studies did not support our finding; they found a high prevalence of CKD in stage 2 (eGFR, 60–89.9) 20,26. The reason for this difference could be that in our study eGFR values between 60–89.9 were not considered as presence of CKD because we could not measure urine albumin as another alternative mean values for determining CKD when eGFR values were >60.…”

“…However, this study had higher prevalence than the study conducted in Tanzania (1.2%) 26. In this study, stage 3 (eGFR, 30–59.9) was the highest (100% vs. 93.7%) among the CKD patients before and after treatment, but the results of previous studies did not support our finding; they found a high prevalence of CKD in stage 2 (eGFR, 60–89.9) 20,26.…”

“…Taking gender into account, a higher proportion of females (62.2%) were recruited; this higher proportion might indicate their ease of susceptibility to HIV infection due to biological and other factors. In the logistic regression analysis, female gender was found to be a risk factor for CKD with an AOR of 2.5 (1.0–6.0), which agrees with the study conducted in San Diego, California, which reported a reduction in GFR for female gender,27 but does not agree with the study conducted in Tanzania26 with an odds ratio of 1.5 (0.7–3.3). This study shows an increment for patients aged >40 years old in the likelihood of developing CKD (8.8% vs. 17.5%) before and after treatment, which is high when compared with that for those <40 years of age, which agrees with the study conducted in San Diego, California, reported as per 10-year increase there was a significant development of CKD 27…”

High blood pressure and associated risk factors among women attending antenatal clinics in Tanzania

“…Proteinuria could be a result of chronic kidney disease which may have resulted from high BP [40,41]. HIV infection has been associated with both acute kidney injury and chronic kidney disease [42], and studies in Africa reported improvement of kidney function with the use of ART [43,44]; thus the higher prevalence of HDP among people who had not started antiretroviral drugs compared to these already using them could be explained.…”

Renal dysfunction among HIV-infected patients starting antiretroviral therapy in Mwanza, Tanzania

“…However, it is important to take into account the high prevalence of HIV and schistosomiasis coinfection in the region and the association between schistosomiasis and renal dysfunction when interpreting these results. Despite the fact that these patients later showed significant improvement in their renal function after using ART for a median of 2 years [17], the high prevalence of schistosomiasis in the study setting may also be a significant contributing factor to renal dysfunction. Another study that includes schistosomiasis infection is needed to establish a clearer picture of the cause of renal dysfunction in this patient population.…”