title: Impact of antiretroviral therapy on renal function among HIV-infected Tanzanian adults: a retrospective cohort study.
abstract: BACKGROUND
  Data regarding the outcomes of HIV-infected adults with baseline renal dysfunction who start antiretroviral therapy are conflicting.
  
  
  METHODS
  We followed up a previously-published cohort of HIV-infected adult outpatients in northwest Tanzania who had high prevalence of renal dysfunction at the time of starting antiretroviral therapy (between November 2009 and February 2010). Patients had serum creatinine, proteinuria, microalbuminuria, and CD4(+) T-cell count measured at the time of antiretroviral therapy initiation and at follow-up. We used the adjusted Cockroft-Gault equation to calculate estimated glomerular filtration rates (eGFRs).
  
  
  RESULTS
  In this cohort of 171 adults who had taken antiretroviral therapy for a median of two years, the prevalence of renal dysfunction (eGFR <90 mL/min/1.73 m(2)) decreased from 131/171 (76.6%) at the time of ART initiation to 50/171 (29.2%) at the time of follow-up (p<0.001). Moderate dysfunction (eGFR<60 mL/min/1.73 m(2)) decreased from 21.1% at antiretroviral therapy initiation to 1.1% at follow-up (p<0.001), as did the prevalence of microalbuminuria (72% to 44%, p<0.001). Use of tenofovir was not associated with renal dysfunction at follow-up.
  
  
  CONCLUSIONS
  Mild and moderate renal dysfunction were common in this cohort of HIV-infected adults initiating antiretroviral therapy, and both significantly improved after a median follow-up time of 2 years. Our work supports the renal safety of antiretroviral therapy in African adults with mild-moderate renal dysfunction, suggesting that these regimens do not lead to renal damage in the majority of patients and that they may even improve renal function in patients with mild to moderate renal dysfunction.
authors.affiliation: Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania ; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Bonaventura C T
authors.initials: BC
authors.lastname: Mpondo
authors.affiliation: Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania ; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Kalluvya
authors.affiliation: Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania ; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania ; Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Peck
authors.affiliation: Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania ; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Rodrick
authors.initials: R
authors.lastname: Kabangila
authors.affiliation: Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Benson R
authors.initials: BR
authors.lastname: Kidenya
authors.affiliation: Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania ; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Lucheri
authors.initials: L
authors.lastname: Ephraim
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.affiliation: Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania ; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania ; Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006678:HIV / Q000187:drug effects / Q000472:pathogenicity; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D015995:Prevalence; D011379:Prognosis; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013636:Tanzania / Q000453:epidemiology