The baseline glomerular filtration rate, predictive of six-year survival in sub-Saharan African patients on antiretroviral therapy for HIV: Cohort study

Abstract

BackgroundRecently, serious morbidity events associated with initial glomerular filtration rate (GFR) have been described during HIV infection, but this is insufficiently investigated in sub-Saharan Africa very affected by HIV. ObjectiveTo assess the impact of baseline GFR prevailing during the first semester of the HIV infection management on six-year survival in peoples taking antiretroviral therapy. Patients and methodsClosed retrospective cohort study. The death was the expected outcome, the baseline GFR (mL/min/1.73m2) in the first semester of the follow-up was the main exposure. Kaplan–Meier method, Cox regression were used for analysis. ResultsAccording to baseline GFR: <60, 60–89 and≥90, the six-year survival was 81.6%; 95.8% and 96.4% (P=0.067 Breslow). Adjusted hazard ratio for baseline GFR<60 and 60–89 (vs. ≥90) were respectively 5.4 (95%CI: 1.4–19.9; P=0.012) and 1.2 (95%CI: 0.3–4.0; P=0.754). The etiological fraction of deaths attributable to baseline GFR: GFR<60: 81% (95%CI: 0.31–0.95), GFR=60–89: 18.0% (95%CI: −0.7–0.8). Prognostic concordance index=0.84 (95%CI: 0.59–0.95) for GFR<60 and 0.55 (95%CI: 0.27–0.81) for GFR 60–89. DiscussionThe etiological fraction of death and prognostic concordance index associated to baseline GFR level increase significantly with decline of baseline GFR. ConclusionBaseline GFR seems to predict the six-year survival in African sub-Saharan patients treated for HIV.