Assessing Renal Impairment in Treatment-Naïve Adolescents Living with HIV Commencing Antiretroviral Therapy In Zimbabwe.

Byers, Bradley W; Drak, Douglas; Shamu, Tinei; Chimbetete, Cleophas; Dahwa, Rumbidzai; Gracey, David M (2023). Assessing Renal Impairment in Treatment-Naïve Adolescents Living with HIV Commencing Antiretroviral Therapy In Zimbabwe. AIDS, 37(5), pp. 789-794. Wolters Kluwer Health 10.1097/QAD.0000000000003482

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OBJECTIVE

People living with HIV (PLWHIV) are increasingly experiencing non-communicable complications, including renal impairment, which are associated with worse clinical outcomes. Limited information exists surrounding renal impairment in paediatric PLWHIV, of which the majority live in sub-Saharan Africa, and further information is required to guide clinical practice. This study describes the prevalence of new or worsening renal impairment in adolescents commencing antiretroviral therapy (ART) in Zimbabwe and associated risk factors.

DESIGN

Retrospective cohort study.

METHODS

Data were collected between January 2010 to January 2019 from the medical records of adolescents aged 12-17 years initiating ART at an outpatient HIV clinic in Zimbabwe. Renal function (eGFR) was calculated using the Full Age Spectrum formula. Proteinuria was defined as a single urine dipstick score of ≥1+. Potential predictors of renal impairment at follow-up were assessed by logistical regression.

RESULTS

266 adolescents were included in analysis. Baseline renal impairment (eGFR <90 ml/min/1.73m2) and proteinuria were present in 13% and 7% of the cohort, respectively. After a median of 4.1 years (IQR 1.9, 6.9) following ART commencement, mean eGFR increased by 10 ml/min/1.73m2 (p < 0.01), and the prevalence of renal impairment decreased to 8% (p < 0.01). Baseline renal impairment predicted renal impairment at follow-up (OR 8.98; 95%CI 2.81, 28.68; p < 0.01). Proteinuria trended towards association with renal impairment at follow-up (OR 4.39; 95%CI 0.95, 20.31; p = 0.06).

CONCLUSIONS

Renal impairment is common in adolescent ART-naïve PLWHIV, and baseline renal impairment is associated with longstanding renal impairment, while baseline proteinuria trended towards an association with longstanding renal impairment.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Shamu, Tinei

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1473-5571

Publisher:

Wolters Kluwer Health

Language:

English

Submitter:

Pubmed Import

Date Deposited:

07 Feb 2023 12:12

Last Modified:

18 Jan 2024 00:25

Publisher DOI:

10.1097/QAD.0000000000003482

PubMed ID:

36728249

BORIS DOI:

10.48350/178313

URI:

https://boris.unibe.ch/id/eprint/178313

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