TITLE:
Incidence of Nephropathy in HIV Infected Patients Receiving Highly Active Antiretroviral Therapy at Newlands Clinic: A Retrospective Study
AUTHORS:
T. Shamu, M. Wellington, M. Pascoe, L. Gwanzura, C. E. Ndhlovu
KEYWORDS:
Zimbabwe, Nephropathy, ART Management, HIV, Creatinine Clearance
JOURNAL NAME:
World Journal of AIDS,
Vol.5 No.2,
June
11,
2015
ABSTRACT: Introduction: HIV infected patients on
antiretroviral therapy (ART) are at risk of developing nephropathy and
therefore require monitoring of renal function. Some medications used in the
management of HIV, opportunistic infections (OIs) and other comorbidities are
nephrotoxic and may further compromise renal function, underlining the
importance of regular monitoring of renal function. This study was designed to
determine the incidence of nephropathy in HIV infected patients on
antiretroviral therapy (ART) at Newlands Clinic and to determine the associated
risk factors. Methodology: A retrospective cohort study was conducted involving
1986 HIV-1 infected participants who were commenced on ART between January 2007
and December 2013 at Newlands Clinic. The majority of participants were female
(1340 (67.5%)). All participants were aged 18 or older at ART commencement.
Participants with pre-existing nephropathy at baseline were excluded.
Nephropathy was defined as two consecutive calculated creatinine clearances (CrCl)
less than 60 ml/min by the Cockcroft-Gault equation, or two consecutive urine
dipsticks positive for protein (≥30 g/L albumin). Data collected during routine
patient visits were exported from the clinic’s database and analysed for
incidence of nephropathy and risk factors. Results: During the follow-up
period, 93 of the 1986 participants (4.7%) developed nephropathy. The estimated
incidence rate (IR) of nephropathy was 1.45/100 person years (CI: 1.17 -
1.78). In the multivariate analysis, statistically significant risk factors
were baseline age > 45 (HR 2.30, CI: 1.50 - 3.55), diabetes mellitus (HR
4.12, CI: 1.75 - 9.69), pulmonary tuberculosis (HR 2.00, CI: 1.28 - 3.12), and
HIV wasting syndrome (HR 2.72, CI: 1.30 - 5.68). Conclusion: The incidence of
nephropathy was low in this cohort. The traditional risk factors for renal
disease; older age and diabetes mellitus were significant, as well as HIV
wasting syndrome and pulmonary tuberculosis. HIV care should be complimented
with proper diabetic care and patients that develop pulmonary tuberculosis, HIV
wasting syndrome or are initiated on ART above 45 years require regular
monitoring for early detection of nephropathy.