Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr 6;5(4):ofy072.
doi: 10.1093/ofid/ofy072. eCollection 2018 Apr.

Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania

Herry Mapesi  1   2   3 , Aneth V Kalinjuma  1 , Alphonce Ngerecha  4 , Fabian Franzeck  5 , Christoph Hatz  2   3 , Marcel Tanner  2   3 , Michael Mayr  5   6 , Hansjakob Furrer  7 , Manuel Battegay  3   5 , Emilio Letang  1   2   3   8 , Maja Weisser  1   2   3 , Tracy R Glass  2   3 ; KIULARCO Study Group
Collaborators, Affiliations

Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania

Herry Mapesi et al. Open Forum Infect Dis. .

Abstract

Background: We assessed the prevalence, incidence, and predictors of renal impairment among people living with HIV (PLWHIV) in rural Tanzania.

Methods: In a cohort of PLWHIV aged ≥15 years enrolled from January 2013 to June 2016, we assessed the association between renal impairment (estimated glomerural filtration rate < 90 mL/min/1.73 m2) at enrollment and during follow-up with demographic and clinical characteristcis using logistic regression and Cox proportional hazards models.

Results: Of 1093 PLWHIV, 172 (15.7%) had renal impairment at enrollment. Of 921 patients with normal renal function at baseline, 117 (12.7%) developed renal impairment during a median follow-up (interquartile range) of 6.2 (0.4-14.7) months. The incidence of renal impairment was 110 cases per 1000 person-years (95% confidence interval [CI], 92-132). At enrollment, logistic regression identified older age (adjusted odds ratio [aOR], 1.79; 95% CI, 1.52-2.11), hypertension (aOR, 1.84; 95% CI, 1.08-3.15), CD4 count <200 cells/mm3 (aOR, 1.80; 95% CI, 1.23-2.65), and World Health Organization (WHO) stage III/IV (aOR, 3.00; 95% CI, 1.96-4.58) as risk factors for renal impairment. Cox regression model confirmed older age (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.56-2.20) and CD4 count <200 cells/mm3 (aHR, 2.05; 95% CI, 1.36-3.09) to be associated with the development of renal impairment.

Conclusions: Our study found a low prevalence of renal impairment among PLWHIV despite high usage of tenofovir and its association with age, hypertension, low CD4 count, and advanced WHO stage. These important and reassuring safety data stress the significance of noncommunicable disease surveillance in aging HIV populations in sub-Saharan Africa.

Keywords: HIV; renal impairment; sub-Saharan Africa.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Patients’ flow chart.
Figure 2.
Figure 2.
Evolution of eGFR among patients after enrollment. Average evolution of eGFR among patients. A, All patients. B, Patients presented with eGFR <90 mL/min/1.73 m2. C, Patients with eGFR <60 mL/min/1.73 m2. D, Patients with eGFR <30 mL/min/1.73 m2. Abbreviations: eGFR, estimated glomerular filtration rate, CI, confidence interval.
See this image and copyright information in PMC

References

    1. Mills EJ, Bakanda C, Birungi J, et al. . Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Intern Med 2011; 155:209–16. - PubMed
    1. Johnson LF, Mossong J, Dorrington RE, et al. ; International Epidemiologic Databases to Evaluate AIDS Southern Africa Collaboration Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med 2013; 10:e1001418. - PMC - PubMed
    1. Selik RM, Byers RH Jr, Dworkin MS. Trends in diseases reported on U.S. death certificates that mentioned HIV infection, 1987–1999. J Acquir Immune Defic Syndr 2002; 29:378–87. - PubMed
    1. Choi AI, Li Y, Deeks SG, et al. . Association between kidney function and albuminuria with cardiovascular events in HIV-infected persons. Circulation 2010; 121:651–8. - PMC - PubMed
    1. Choi A, Scherzer R, Bacchetti P, et al. . Cystatin C, albuminuria, and 5-year all-cause mortality in HIV-infected persons. Am J Kidney Dis 2010; 56:872–82. - PMC - PubMed