Decreased kidney function in a community-based cohort of HIV-Infected and HIV-negative individuals in Rakai, Uganda.
BACKGROUND
High prevalences of reduced glomerular filtration rate (GFR) have been reported from HIV-infected individuals in sub-Saharan Africa when initiating antiretroviral therapy. However little is known about natural history HIV-related kidney disease or about background rates of reduced GFR in HIV-negative individuals in this region.


METHODS
We estimated GFR from first and last available stored serum samples from 1202 HIV-infected and 664 age-matched and sex-matched HIV-negative individuals in a community-based cohort of HIV-infected and HIV-negative individuals in Rakai, Uganda, between 1994 and 2003. We assessed the prevalence and incidence of mildly (60-89 ml·min·1.73 m) and moderately (<60 ml·min·1.73 m) reduced GFR using standard analytical methods.


RESULTS
At baseline, 8.4% of HIV-infected and 4.7% of HIV-negative individuals had mildly or moderately reduced GFR (P = 0.002). During follow-up, the rates of decline to a lower GFR category were of 32.4 and 20.3 per 1000 person-years in HIV-infected and HIV-negative subjects, respectively (P = 0.019).


CONCLUSIONS
In an unselected community sample of HIV-infected individuals followed in Rakai, Uganda, before the availability of antiretroviral therapy, the prevalence of decreased GFR and the incidence of a decline in GFR category during follow-up were both significantly higher in HIV-infected subjects compared with HIV-negative subjects, although moderately reduced GFR was uncommon.
Lucas
Gregory M
GM
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. glucas@jhmi.edu
Clarke
William
W
Kagaayi
Joseph
J
Atta
Mohamed G
MG
Fine
Derek M
DM
Laeyendecker
Oliver
O
Serwadda
David
D
Chen
Michael
M
Wawer
Maria J
MJ
Gray
Ronald H
RH
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D018023:HIV Seronegativity; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology* / Q000821:virology*; D008297:Male; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology
D044966:Anti-Retroviral Agents