Abstract
BackgroundIn the United States, HIV-related kidney disease disproportionately affects individuals of African descent; however, there are few estimates of kidney disease prevalence in Africa. We evaluated the prevalence of kidney disease among HIV-infected and uninfected Rwandan women.MethodsThe Rwandan Women's Interassociation Study and Assessment prospectively enrolled 936 women. Associations with estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2 and proteinuria were assessed in separate logistic regression models.ResultsAmong 891 non-pregnant women with available data, 2.4% had an eGFR<60 mL/min/1.73 m2 (calculated by the Modification of Diet in Renal Disease equation, MDRD eGFR) and 8.7% had proteinuria ≥1+. The prevalence of decreased eGFR varied markedly depending on the estimating method used, with the highest prevalence by Cockcroft-Gault. Regardless of the method used to estimate GFR, the proportion with decreased eGFR or proteinuria did not differ significantly between HIV-infected and -uninfected women in unadjusted analysis. After adjusting for age and blood pressure, HIV infection was associated with significantly higher odds of decreased MDRD eGFR but not proteinuria.ConclusionIn a well-characterized cohort of Rwandan women, HIV infection was associated with decreased MDRD eGFR. The prevalence of decreased eGFR among HIV-infected women in our study was lower than that previously reported in African-Americans and in other Central and East African HIV populations, although there was substantial variability depending on the equation used to estimate GFR. Future studies are needed to optimize GFR estimates and to determine the impact of antiretroviral therapy on kidney disease in this population.
Highlights
In 2008 there were an estimated 33.4 million individuals living with human immunodeficiency virus (HIV) infection
Strong genetic susceptibility to chronic kidney disease (CKD) and end-stage renal disease (ESRD) has been observed in African-Americans [2,3,4], and the risk of ESRD is as much as 30-fold higher among HIVinfected Americans of African compared to European descent [5,6]
We considered an estimated glomerular filtration rate (eGFR) cutoff of 50 mL/min/ 1.73 m2, the level at which dose adjustment is recommended for most nucleotide reverse transcriptase inhibitors (NRTI)
Summary
In 2008 there were an estimated 33.4 million individuals living with human immunodeficiency virus (HIV) infection. SubSaharan Africa bears the greatest burden of disease, with twothirds of all HIV-infected individuals [1]. Epidemiological data on CKD in sub-Saharan Africa are scarce, and available data demonstrate substantial variability in CKD prevalence across different African HIV populations [7,8,9,10]. The regional prevalence of CKD may influence the approach to screening and monitoring of HIV-infected individuals initiating antiretroviral therapy (ART). In the United States, HIV-related kidney disease disproportionately affects individuals of African descent; there are few estimates of kidney disease prevalence in Africa. We evaluated the prevalence of kidney disease among HIV-infected and uninfected Rwandan women
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