Antiretroviral therapy dose adjustments based on calculated creatinine clearance.
BACKGROUND
Whereas therapy for HIV is dependent on level of creatinine clearance, most laboratories locally only report an absolute creatinine value. There is likelihood that the patients already on antiretroviral therapy (ART) may have required dosage adjustment at the time of initiation of therapy or sometime during ongoing therapy. This paper explores a group of patients who are already on ART to determine their creatinine clearance and assess the need for ART dose adjustment.


OBJECTIVE
To determine the proportion of stable HIV outpatients who have a documented creatinine clearance (CrCI) and the proportion requiring antiretroviral drug dose adjustments depending on their creatinine clearance.


METHODS
Retrospective observational study.


METHODS
One stop HIV medical clinic, Aga Khan University Hospital, Nairobi between January and February 2007.


METHODS
Ninety three patients seen.


RESULTS
None of the study subjects had a calculated creatinine clearance in their medical records. Fifteen of the 93 patients (16.1%) had no serum creatinine performed in the twelve months preceding the last clinic visit. Nine of the remaining 78 patients (11.5%) had evidence of renal insufficiency (CrCI <60mls/min) as estimated by the Cockroft Gault method, with six patients (7.7%) requiring dose adjustments to the one or more drugs in their antiretroviral therapy (ART) regime (CrCI <50mls/min).


CONCLUSIONS
It is imperative to have a CrCI prior to and during follow up of patients with HIV disease on ART to reduce potential drug toxicities and interactions, especially with the increased utilisation of newer and potentially more nephrotoxic antiretrovirals.
Shavadia
J
J
Aga Khan University Hospital, Nairobi, Kenya.
Tesfaldet
G
G
Twahir
M
M
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood / Q000378:metabolism*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D012189:Retrospective Studies
D019380:Anti-HIV Agents; D003404:Creatinine