The prevalence of renal impairment among adults with early HIV disease in Blantyre, Malawi

Gerson Struik, RA den Exter, C Munthali, D Chipeta, JJG van Oosterhout, Jan Nouwen, TJ Allain

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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-naive subjects, 67% women, median age 34 (17-73) years and mean CD4 count 305 (3-993) cells/mu L. 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.
Original languageUndefined/Unknown
Pages (from-to)457-462
Number of pages6
JournalInternational Journal of Std & Aids
Volume22
Issue number8
DOIs
Publication statusPublished - 2011

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