Abstract
IntroductionOur systematic scoping review has demonstrated a research gap in antiretroviral treatment (ART) nephrotoxicity as well as in the long-term outcomes of renal function for patients on ART in South Africa. Bearing in mind the high prevalence of human immunodeficiency virus (HIV) in South Africa, this is of great concern.ObjectivesTo determine the risk factors and co-morbidities associated with changes in renal function in HIV-infected adults in South Africa.MethodsWe conducted a retrospective study of 350 ART-naïve adult patients attending the King Edward VIII HIV clinic, Durban, South Africa. Data were collected at baseline (pre-ART) and at six, 12, 18 and 24 months on ART. Renal function was assessed in the 24-month period using the Modification of Diet in Renal Disease equation and was categorised into normal renal function (estimated glomerular filtration rate [eGFR] ≥ 60), moderate renal impairment (eGFR 30–59), severe renal impairment (eGFR 15–29) and kidney failure (eGFR < 15 mL/min/1.73 m2). Generalised linear models for binary data were used to model the probability of renal impairment over the five time periods, controlling for repeated measures within participants over time. Risk ratios and 95% confidence intervals (CI) were reported for each time point versus baseline.ResultsThe cohort was 64% female, and 99% were Black. The median age was 36 years. At baseline, 10 patients had hypertension (HPT), six had diabetes, 61 were co-infected with tuberculosis (TB) and 157 patients had a high body mass index (BMI) with 25.4% being categorised as overweight and 19.4% as obese. The majority of the patients (59.3%) were normotensive. At baseline, the majority of the patients (90.4%) had normal renal function (95% CI: 86% – 93%), 7.0% (CI: 5% – 10%) had moderate renal impairment, 1.3% (CI: 0% – 3%) had severe renal impairment and 1.3% (CI: 0% – 3%) had renal failure. As BMI increased by one unit, the risk of renal impairment increased by 1.06 (CI: 1.03–1.10) times. The association of HPT with abnormal renal function was found to be insignificant, p > 0.05. The vast majority of patients were initiated on tenofovir disoproxil fumarate (TDF) (90.6%), in combination with lamivudine (3TC) (100%) and either efavirenz (EFV) (56.6%) or nevirapine (NVP) (43.4%).ConclusionThis study reports a low prevalence of baseline renal impairment in HIV-infected ART-naïve outpatients. An improvement in renal function after the commencement of ART has been demonstrated in this population. However, the long-term outcomes of patients with HIV-related renal disease are not known.
Highlights
Our systematic scoping review has demonstrated a research gap in antiretroviral treatment (ART) nephrotoxicity as well as in the long-term outcomes of renal function for patients on ART in South Africa
In an attempt to end the surge of human immunodeficiency virus (HIV) plaguing the African continent, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has established an ambitious but achievable target to have 90% of all people tested for HIV and treated and virologically suppressed by 2020.3 Providing antiretroviral treatment (ART) to all people living with HIV (PLHIV) irrespective of CD4 count can help prevent HIV-related illness, avert acquired immune deficiency syndrome (AIDS)-related deaths and prevent new HIV infections.[3]
This study shows a low prevalence of baseline renal impairment among HIV-infected, ART-naïve outpatients and an improvement in renal function after the commencement of ART
Summary
Our systematic scoping review has demonstrated a research gap in antiretroviral treatment (ART) nephrotoxicity as well as in the long-term outcomes of renal function for patients on ART in South Africa. Bearing in mind the high prevalence of human immunodeficiency virus (HIV) in South Africa, this is of great concern. South Africa accounts for approximately 18% of global human immunodeficiency virus (HIV) infections with an estimated prevalence of 6.7 million HIV-infected people.[1] There are almost 1000 new HIV infections, the majority of which are heterosexually transmitted.[2] In an attempt to end the surge of HIV plaguing the African continent, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has established an ambitious but achievable target to have 90% of all people tested for HIV and treated and virologically suppressed by 2020.3 Providing antiretroviral treatment (ART) to all people living with HIV (PLHIV) irrespective of CD4 count can help prevent HIV-related illness, avert acquired immune deficiency syndrome (AIDS)-related deaths and prevent new HIV infections.[3] South Africa implemented the UNAIDS policy in September 2016.4 This universal access to ART for PLHIV is likely to lead to an increase in the burden of chronic diseases in South Africa as people are living longer with HIV.[5] http://www.sajhivmed.org.za Open Access. The South African ART guidelines recommend a serum creatinine and creatinine clearance at baseline (prior to ART initiation) and at three months, six months and annually thereafter for patients on TDF.[13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
