Severe Renal Dysfunction and Risk Factors Associated with Renal Impairment in HIV-Infected Adults in Africa Initiating Antiretroviral Therapy.
Background. We sought to investigate renal function in previously untreated symptomatic human immunodeficiency virus (HIV)-infected adults with CD4+ cell counts of
Methods. The study was an observational analysis within a randomized trial of ART management strategies that included 3316 participants with baseline serum creatinine levels of 360 μmol/L. Creatinine levels were measured before ART initiation, at weeks 4 and 12 of therapy, and every 12 weeks thereafter. We calculated estimated glomerular filtration rate (eGFR) using the Cockcroft-Gault formula. We analyzed the incidence of severely decreased eGFR (
Results. Sixty-five percent of the participants were women. Median values at baseline were as follows: age, 37 years; weight, 57 kg; CD4+ cell count, 86 cells/mm3; and eGFR, 89 mL/min/1.73 m2. Of the participants, 1492 (45%) had mild (60 but
Conclusions. Despite screening, mild-to-moderate baseline renal impairment was relatively common, but these participants had greatest increases in eGFR after starting ART. Severe eGFR impairment was infrequent regardless of ART regimen and was generally related to intercurrent disease. Differences between ART regimens with respect to changes in eGFR through 96 weeks were of marginal clinical relevance, but investigating longer-term nephrotoxicity remains important.
Clinical Infectious Diseases (2008) 46 (8) 1271-1281 [doi: 10.1086/533468]