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The prevalence of renal impairment among adults with early HIV disease in Blantyre, Malawi.

Abstract
We determined the prevalence of renal impairment and possible HIV-associated nephropathy (HIVAN) in adults with World Health Organization (WHO) stages I or II HIV, presenting to the antiretroviral therapy (ART) clinic in a central hospital in Malawi. We enrolled 526 ART-naïve subjects, 67% women, median age 34 (17-73) years and mean CD4 count 305 (3-993) cells/μL. Blood pressure, weight, urine dipstick and microscopy, CD4 cell count and serum creatinine were measured. Creatinine clearance (CrCL) was estimated using the Cockcroft-Gault equation. Possible HIVAN was diagnosed based on levels of proteinuria and CrCl. In all, 23.3% had proteinuria (≥ 1+). 57.4% had reduced CrCl (< 90 mL/minute): 18.8% had moderate (CrCl 30-59 mL/minute) and 2.2% severe (CrCl <30 mL/minute) renal dysfunction. Extrapolating from renal biopsy studies that confirmed HIVAN, the proportion of patients with HIVAN in our clinic ranges from 1.8-21.2%. We conclude that renal impairment was common, though rarely severe, among HIV-infected adults with clinically non-advanced HIV disease. Renal dysfunction has been demonstrated to be a risk factor for (early) mortality. These results are relevant for ART programmes, such as those in Malawi, where renal function is not routinely assessed.
AuthorsG M Struik, R A den Exter, C Munthali, D Chipeta, J J G van Oosterhout, J L Nouwen, T J Allain
JournalInternational journal of STD & AIDS (Int J STD AIDS) Vol. 22 Issue 8 Pg. 457-62 (Aug 2011) ISSN: 1758-1052 [Electronic] England
PMID21795419 (Publication Type: Journal Article)
Chemical References
  • Creatinine
Topics
  • AIDS-Associated Nephropathy (diagnosis, epidemiology, urine)
  • Adolescent
  • Adult
  • Aged
  • CD4 Lymphocyte Count
  • Chi-Square Distribution
  • Creatinine (urine)
  • Cross-Sectional Studies
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Logistic Models
  • Malawi (epidemiology)
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Proteinuria (epidemiology, urine)
  • Renal Insufficiency (diagnosis, epidemiology, urine, virology)
  • Risk Factors
  • Surveys and Questionnaires
  • Young Adult

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