Revista de SIDA e investigación clínica

Renal Dysfunction among HIV-infected Patients on Tenofovir-Based Antiretroviral Therapy at Ronald Ross Hospital in Zambia

Abstract

Wantakisha E, Chongwe G, Munkombwe D and Michelo C

Objective: Tenofovir Disoproxil Fumerate (TDF) is contraindicated for use in HIV infected patients when creatinine clearance (CrCl) is below 50ml/min. We determined prevalence and factors associated with renal dysfunction at 18 months follow up in adult HIV positive patients on TDF-based antiretroviral therapy (ART). Methods: We conducted a cross sectional study of 445 HIV positive patients’ records on a TDF-regimen at Ronald Ross General Hospital in Zambia. Patient’s records in data management software (SMARTCARE) from 2008 to 2014 were reviewed to determine proportions of patients on TDF developing renal dysfunction. We estimated glomerular filtration rate (GFR) by creatinine clearance using the Cockcroft-Gault formula to determine renal dysfunction. CrCl level ≤ 50 ml/min indicated renal dysfunction. Multiple logistic regression was used to determine factors associated with renal dysfunction. Results: At baseline (n=429), median age of patients was 35 years (IQR 30, 42), median CrCl level 106.2 ml/ min (IQR: 79.9, 127.8). At 18 months, median CrCl 102 ml/min (IQR: 81.6, 123.2) which remained within normal physiological range (88-137 ml/min). Point prevalence of renal dysfunction was 18.6% (95% CI; 0.2-28.3). Multivariable analysis showed that ages <50 years than older (AOR: 0.06 95%CI 0.01-0.27; p<0.0001), and those with higher CD4+ cell count ≥ 350 cells/uL than lower (AOR: 0.19 95%CI 0.03-0.21; P=0.014) had lower likelihood of renal dysfunction. Conclusion: We found a high prevalence of renal dysfunction among HIV positive adults on tenofovir-based therapy. This was concentrated in older patients with low CD4+ cell counts suggesting a need for close renal function monitoring in this population when initiating tenofovir-based treatment.