title: Renal dysfunction among HIV-infected patients starting antiretroviral therapy.
abstract: OBJECTIVE
  HIV-related renal dysfunction is associated with high mortality. Data on the prevalence of renal dysfunction among HIV-infected outpatients starting antiretroviral therapy (ART) in sub-Saharan Africa are limited. Recent recommendations to include the nephrotoxic drug tenofovir in first-line ART regimens make clarification of this issue urgent.
  
  
  METHODS
  We screened for renal dysfunction by measuring serum creatinine, proteinuria, and microalbuminuria in HIV-positive outpatients initiating ART in Mwanza, Tanzania. We excluded patients with pre-existing renal disease, hypertension, diabetes, or hepatitis C virus co-infection. Estimated glomerular filtration rates (eGFRs) were calculated by Cockroft-Gault and Modification of Diet in Renal Disease equations.
  
  
  RESULTS
  Only 129 (36%) of 355 enrolled patients had normal eGFRs (grade 0 or 1) above 90 ml/min per 1.73 m. Grade 2 renal dysfunction (eGFR between 60 and 89 ml/min per 1.73 m) was present in 137 patients (38.6%), and 87 patients (25%) had grade 3 dysfunction (eGFR between 30 and 59 ml/min per 1.73 m). Microalbuminuria and proteinuria were detected in 72 and 36% of patients, respectively. Factors predictive of renal dysfunction in multivariate analysis included female sex [odds ratio (OR) 3.0, 95% confidence interval (1.8-5.1), P < 0.0001], BMI less than 18.5 [OR 2.3 (1.3-4.1), P = 0.004], CD4 T-cell count below 200 cells/μl [OR 2.3 (1.1-4.8), P = 0.04], and WHO clinical stage II or above [OR 1.6 (1.2-2.3), P = 0.001].
  
  
  CONCLUSIONS
  Renal dysfunction was highly prevalent in this population of HIV-positive outpatients initiating first ART in Tanzania. This highlights the critical and underappreciated need to monitor renal function in HIV-positive patients in sub-Saharan Africa, particularly given the increasing use of tenofovir in first-line ART.
authors.affiliation: Weill Bugando University College of Health Sciences, Mwanza, Tanzania.
authors.forename: Leonard
authors.initials: L
authors.lastname: Msango
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Kalluvya
authors.forename: Benson R
authors.initials: BR
authors.lastname: Kidenya
authors.forename: Rodrick
authors.initials: R
authors.lastname: Kabangila
authors.forename: Warren D
authors.initials: WD
authors.lastname: Johnson
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.forename: Robert N
authors.initials: RN
authors.lastname: Peck
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D006801:Humans; D008297:Male; D015995:Prevalence; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D012307:Risk Factors; D013636:Tanzania
chemical_list: D044966:Anti-Retroviral Agents