Risk factors and co-morbidities associated with changes in renal function among antiretroviral treatment-naïve adults in South Africa: A chart review

Abstract

IntroductionOur systematic scoping review has demonstrated a research gap in antiretroviral treatment (ART) nephrotoxicity as well as in the long-term outcomes of renal function for patients on ART in South Africa. Bearing in mind the high prevalence of human immunodeficiency virus (HIV) in South Africa, this is of great concern.ObjectivesTo determine the risk factors and co-morbidities associated with changes in renal function in HIV-infected adults in South Africa.MethodsWe conducted a retrospective study of 350 ART-naïve adult patients attending the King Edward VIII HIV clinic, Durban, South Africa. Data were collected at baseline (pre-ART) and at six, 12, 18 and 24 months on ART. Renal function was assessed in the 24-month period using the Modification of Diet in Renal Disease equation and was categorised into normal renal function (estimated glomerular filtration rate [eGFR] ≥ 60), moderate renal impairment (eGFR 30–59), severe renal impairment (eGFR 15–29) and kidney failure (eGFR < 15 mL/min/1.73 m2). Generalised linear models for binary data were used to model the probability of renal impairment over the five time periods, controlling for repeated measures within participants over time. Risk ratios and 95% confidence intervals (CI) were reported for each time point versus baseline.ResultsThe cohort was 64% female, and 99% were Black. The median age was 36 years. At baseline, 10 patients had hypertension (HPT), six had diabetes, 61 were co-infected with tuberculosis (TB) and 157 patients had a high body mass index (BMI) with 25.4% being categorised as overweight and 19.4% as obese. The majority of the patients (59.3%) were normotensive. At baseline, the majority of the patients (90.4%) had normal renal function (95% CI: 86% – 93%), 7.0% (CI: 5% – 10%) had moderate renal impairment, 1.3% (CI: 0% – 3%) had severe renal impairment and 1.3% (CI: 0% – 3%) had renal failure. As BMI increased by one unit, the risk of renal impairment increased by 1.06 (CI: 1.03–1.10) times. The association of HPT with abnormal renal function was found to be insignificant, p > 0.05. The vast majority of patients were initiated on tenofovir disoproxil fumarate (TDF) (90.6%), in combination with lamivudine (3TC) (100%) and either efavirenz (EFV) (56.6%) or nevirapine (NVP) (43.4%).ConclusionThis study reports a low prevalence of baseline renal impairment in HIV-infected ART-naïve outpatients. An improvement in renal function after the commencement of ART has been demonstrated in this population. However, the long-term outcomes of patients with HIV-related renal disease are not known.

Determinants of Risk Factors for Renal Impairment among HIV-Infected Patients Treated with Tenofovir Disoproxil Fumarate-Based Antiretroviral Regimen in Southern Vietnam

“…We also found a low prevalence of renal impairment among study participants. is finding was consistent with findings in South Africa (7.6%) [13] and Malaysia 9.3% [17], lower than in Korean (14.4%) [22] and Japan (22.1%) [12], and higher than in Spain (4-5%) [23].…”

“…In this study, renal impairment was defined as eGFR less than 60 ml/min/1.73 m 2 [13]. In the univariate analysis, we used Chi-squared and Fisher's exact tests to assess bivariate relationships.…”

“…is could be explained that differences in genetic factors correlated with an inherited polymorphism in drug transporter proteins of the renal tubule which led to TDF accumulation in the proximal tubular cells [24,25], and several studies also showed that HIV affected direct renal pathogenic role [13,26,27].…”

“…According to Decision 5418/QD-BYT of the Ministry of Health in 2017 stipulating monitoring serum creatinine test before and during ARV treatment, this test was performed every 6-12 months or when renal dysfunction was suspected [3,4]. Many studies showed that old age, low BMI, gender, CD4 less than 200 cells/mm 3 , long duration of HIV infection, WHO stage, and coinfection with hepatitis B and hepatitis C were risk factors for renal dysfunction [8][9][10][11][12][13][14][15][16][17]. A study has only followed up HIV patients treated with TDF based regimen within a duration of 24 months [9].…”

Renal function in a cohort of HIV-infected patients initiating antiretroviral therapy in an outpatient setting in Ethiopia

“…Exposure to HIV viremia, chronic inflammation, and potentially nephrotoxic antiretroviral drugs, as well as structural or functional disorders in the context of ageing and associated comorbidities may play a role in the pathogenesis of eGFR decline in HIV-infected patients on ART [ 23 , 43 ]. However, an improvement in eGFR after the commencement of ART has been demonstrated in the Tanzanian, South African and Ugandaian cohort studies [ 20 , 21 , 32 ]. Our results also showed that among patients with baseline normal renal function (eGFR ≥90 ml/min/1.73 m 2 ), 49.7% experienced some degree of renal impairment, which is similar to recent studies done in Tanzania and China [ 29 , 33 ].…”