Renal Dysfunction among HIV-Infected Patients on Antiretroviral Therapy in Dar es Salaam, Tanzania: A Cross-Sectional Study

Abstract

Background. HIV-associated renal dysfunction is common among infected patients; the growing burden of this condition may be partly accounted for by improved survival attributed to sustained viral suppression with antiretroviral therapies (ART). Some ART regimens are nephrotoxic and may potentially contribute to renal dysfunction observed in these patients. This study aimed at investigating the prevalence of renal dysfunction among people living with HIV (PLHIV) on ART attending the care and treatment clinic (CTC). Methods. A cross-sectional study was conducted between June and October 2019 among adults living with HIV on ART for 6 months or more attending CTC at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 287 participants were screened for proteinuria and microalbuminuria using the Cybow 300 urine analyzer. Serum creatinine was tested for all participants, and it was used to estimate glomerular filtration rate (eGFR) using the CKD-EPI formula. Results. Out of 287 participants (72.1% female, mean age ± SD: 46.7 ± 10.6 years), about one-third (32.8%) had eGFR less than 90 ml/min, whereas 7% had eGFR less than 60 ml/min. Microalbuminuria and proteinuria were detected in 38.6% and 25.1% of participants, respectively. In the multivariate analysis, predictive determinants for renal dysfunction were higher viral loads (OR 2.5 (1.1–5.8), p=0.031), diabetes mellitus (OR 5.5 (1.6–18.6), p=0.006), and age above 60 years (OR 2.8 (1.0–7.3), p=0.041); however, this was not the case for serum CD4 counts (OR 1.25 (0.7–2.3), p=0.46). Conclusion. High prevalence of renal dysfunction among PLHIV on ART was noted in this study. Viral loads above 1000 cp/ml and diabetes mellitus were noted to be associated with increased risk for renal dysfunction.

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

“…Increasing age and female sex were signi cantly associated with kidney function impairment in both PLWH and people without HIV. These ndings are consistent with previous studies from Uganda and Africa where increasing age and female sex were associated with kidney disease in both PLWH and people without HIV [18,31,44,45].…”

Prevalence and Risk Factors for Renal Insufficiency among Adults Living with HIV in Tanzania: Results from a Cross-Sectional Study in 2020–2021

“…In this study, age was a strong predictor of reduced eGFR, a finding similar to other studies in SSA [ 10 , 11 , 12 ]. Studies have shown that chronic HIV infection accelerates aging and, even among ALHIV well controlled on ART, there is still an increased risk of age-related renal function loss [ 26 ].…”

“…In Sub-Saharan Africa (SSA), where over two-thirds of the world’s population of ALHIV reside [ 3 ], the pooled prevalence of renal insufficiency among ALHIV is reported to be as high as 12% [ 8 , 9 ]. Renal insufficiency is also common among ALHIV in Tanzania, with prevalence ranging from 7 to 11% [ 10 , 11 , 12 , 13 ].…”

Switching treatment-experienced, integrase inhibitor-naïve, virally suppressed HIV-1 infected adults from ritonavir-boosted protease inhibitors to dolutegravir: design, methods, and baseline results of a randomized, open-label, non-inferiority trial

“…The prevalence of renal dysfunction among other HIV-positive cohorts on ART in sub-Saharan Africa is consistently high. [14][15][16][17] The use of ATV/r and LPV/r have both been associated with increased risk of chronic kidney disease in large observational studies 18,19 and TDF-associated renal toxicity also occurs more often when TDF is co-administered with a boosted PI, 20 so our study population may have been at even higher risk for renal dysfunction having been on PI/r-based ART regimens for a median of 5.4 years before enrollment and with half of them also on TDF.…”