Abstract
BackgroundIt is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa. South Africa has recently adopted WHO policy, stipulating that all HIV-infected patients have access to antiretroviral treatment (ART) irrespective of CD4 cell count.MethodsWe searched Google Scholar, PubMed, Medline, Cochrane Library, Worldcat.org and EBSCO host databases from July 2015 to December 2015. Eligibility criteria included articles pertaining to renal manifestations of HIV in South Africa from 2004 to 2015 in adult patients (≥ 18 years). We independently reviewed the articles for quality. Thematic content analysis was performed to identify patterns of renal manifestations from the included studies. The risk of bias (e.g. internal validity) in the included studies was evaluated using the mixed methods appraisal tool.ResultsEleven out 21 studies were eligible for data extraction. The prevalence of urine abnormalities on urine dipsticks was high but had poor sensitivity and specificity for detecting renal impairment. Normal renal function occurred in 28.4 to 79% of patients, mild renal impairment occurred in 19 to 57.1% and moderate renal impairment in 2 to 14.4%. Severe renal impairment occurred in 1.3% of patients. Both the Cockcroft-Gault equation (after correcting for bias) and the 4-variable Modification of Diet in Renal Disease equation (without the ethnicity factor for African Americans) have been validated for the estimation of glomerular filtration rate (eGFR) in Black South Africans. HIV-associated nephropathy was the most prevalent histology seen (57.2%). Older age, a lower CD4 count, a low haemoglobin and a detectable viral load were associated with renal impairment. Renal function improved in the first year of commencing ART as evidenced by the regression of proteinuria and the increase in eGFR.ConclusionThe findings of the review have implications to the recently adopted ‘test and treat’ approach to HIV prevention and management.Systematic review registrationPROSPERO CRD42016039270
Highlights
It is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa
Nephrotoxicity defined as any decline in kidney function from baseline that is secondary to a toxin documented within 48 months of initiating tenofovir (TDF)
This review provided a general overview of renal impairment in South African HIV-infected patients mainly prior to antiretroviral treatment (ART) initiation
Summary
It is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa. South Africa recently (01 September 2016) adopted the World Health Organization (WHO) “test and treat” approach, which was introduced as a possible means of controlling the global HIV epidemic [3]. This approach entitles every patient who tests positive for HIV to a lifelong ART regardless of their CD4 count or clinical staging [3]. Data from the USA suggest that at some stage of their HIV infection, 10% of patients will develop HIVrelated renal disease [7] If this is extrapolated to the South African context, it is estimated that 650,000 patients may develop HIV-related renal disease [7]. This large burden of chronic kidney disease (CKD) would place immense pressure on our resource-strained health system where access to renal biopsy, renal replacement therapies and nephrologists is limited [8]
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