Auteurs : Auguy L Longo, MD;Francois B Lepira, Ph.D.;Ernest K. Sumaili, MD, Ph.D.;Jean Robert R Makulo, MD;Henri Mukumbi, MD, MPH;Justine B Bukabau, MD;Vieux M Mokoli, MD;Patrick K Kayembe, MD, Ph.D.;Nazaire M Nseka, MD, Ph D
Abstract:
Objective
To evaluate the prevalence of low eGFR, proteinuria and associated risk factors among HIV-infected black patients at primary health care.
Methods: A cross sectional screening involving consecutive HIV-infected-patients aged ≥ 18 years old was done. 88% of patients were receiving HAART (94% on first line regimen: ZDV+3Tc+NVP).
Simplified Modification of Diet in Renal Disease (MDRD) Study and Cockroft-Gault (CG) equations were used to estimate GFR and creatinine clearance (CrCl), respectively. Determinants of dipstick
proteinuria and low kidney function (< 60 ml/min/1.73 m2) were assessed using multivariate logistic regression analysis.
Results: 300 HIV-infected (231 females) were screened. Their mean age, duration of HIV and CD4+ count were 43 ± 9 years, 33 ± 27 months and 397± 224 cells/μl, respectively. The prevalence of low eGFR according to MDRD Study and CG equations was 3% and 10%, respectively. Proteinuria was observed in 20.5% patients. CD4+ ≥ 200 cells/μl alone was associated of low risk of reduced CG CrCl [aOR 0.33; 95% CI 0.12-0.91]. Age ≥ 40 years [aOR 2.25; 95% CI 1.13-4.45], FH-CKD [aOR 3.93; 95% CI 1.01-7.27], central obesity [aOR 2.75; 95% CI 1.12-6.76] were significantly associated with proteinuria, whereas ARV therapy alone was protective [aOR 0.37; 95% CI 0.16-0.82].
Conclusion:
low eGFR and proteinuria are prevalent among these HIV-infected persons. Immunodeficiency emerged as one of the strongest determinants of renal impairment. This finding emphasize the importance of HAART in tackling the burden of CKD in African HIV population.