title: The prevalence of renal impairment among adults with early HIV disease in Blantyre, Malawi.
abstract: We determined the prevalence of renal impairment and possible HIV-associated nephropathy (HIVAN) in adults with World Health Organization (WHO) stages I or II HIV, presenting to the antiretroviral therapy (ART) clinic in a central hospital in Malawi. We enrolled 526 ART-naïve subjects, 67% women, median age 34 (17-73) years and mean CD4 count 305 (3-993) cells/μL. Blood pressure, weight, urine dipstick and microscopy, CD4 cell count and serum creatinine were measured. Creatinine clearance (CrCL) was estimated using the Cockcroft-Gault equation. Possible HIVAN was diagnosed based on levels of proteinuria and CrCl. In all, 23.3% had proteinuria (≥ 1+). 57.4% had reduced CrCl (< 90 mL/minute): 18.8% had moderate (CrCl 30-59 mL/minute) and 2.2% severe (CrCl <30 mL/minute) renal dysfunction. Extrapolating from renal biopsy studies that confirmed HIVAN, the proportion of patients with HIVAN in our clinic ranges from 1.8-21.2%. We conclude that renal impairment was common, though rarely severe, among HIV-infected adults with clinically non-advanced HIV disease. Renal dysfunction has been demonstrated to be a risk factor for (early) mortality. These results are relevant for ART programmes, such as those in Malawi, where renal function is not routinely assessed.
authors.affiliation: The Erasmus University, Rotterdam, Netherlands.
authors.forename: G M
authors.initials: GM
authors.lastname: Struik
authors.forename: R A
authors.initials: RA
authors.lastname: den Exter
authors.forename: C
authors.initials: C
authors.lastname: Munthali
authors.forename: D
authors.initials: D
authors.lastname: Chipeta
authors.forename: J J G
authors.initials: JJ
authors.lastname: van Oosterhout
authors.forename: J L
authors.initials: JL
authors.lastname: Nouwen
authors.forename: T J
authors.initials: TJ
authors.lastname: Allain
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine; D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology / Q000652:urine; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine / Q000821:virology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D003404:Creatinine