Renal failure and use of Highly Active Antiretroviral Therapy in HIV-infected persons at Nkongsamba Regional Hospital - Cameroon

CaHReF 20116, Yaoundé Conges hall, 23 – 26 August 2016 , PL124

Faculty of Medicine and Biomedical Sciences, University of Yaoundé

Chronic kidney disease (CKD) or renal failure is a frequent complication of HIV infection, occurring in 3.5 % - 48.5%, and occurs as a complication of HIV infection, other co-morbid disease and infections and as a consequence of therapy of HIV infection and its complications. The availability and administration of Highly Active Antiretroviral Therapy (HAART) has significantly reduced mortality and morbidity associated with HIV and AIDS. Although renal dysfunction is known to be common among HIV infected persons, data regarding the progression of renal dysfunction after the initiation of HAART are conflicting. We then sought to determine the prevalence of renal failure in HAART-naïve and HAART-experienced HIV-infected persons, and factors associated with kidney dysfunction.

  This cross-sectional study was carried out at the daycare center of the Nkongsamba Regional Hospital from August 2014 to February 2015. A documentary review of medical records, face to face interview and collection of clinical parameters were carried out in HIV infected patients after consenting. Blood samples were collected to measure serum creatinine and determine renal failure using the Cockcroft-Gault equation while dipstick was used for rapid urine analysis. Renal dysfunction was defined as a creatinine clearance (CrCl) < 60 mL/min/. Epi info7 and IBM SPSS 21 were used as statistical tools to analyze data. Multivariate logistic regression was used to identify predictors of renal failure.  

  Out of 406 eligible patients, 315 (77.60%) were female. The mean age was 44.15 (SD = 10.89) years, and women were younger than men (P <0.02). Their median BMI was 23.79 kg/m2 (IQR: 21.30–27.02), 30 (7.39%) patients were underweight while 156 (38.42 %) were obese.  Median CD4 count was 351 cells/mm3 (IQR: 201-568); and 306 (75.56%; P=0.079) patients were receiving HAART. Alcohol use was common among men 60 (69%; P=0.04) while smoking was equally common among male patients (6%; P=0.001). Albuminuria (33.09%; P=0.020) and proteinuria (31.03%; P=0.008) were equally more frequent among men. A total of 58 (14.30 %) patients had renal failure, 20(20.20%) of whom were HAART naïve and 38(12.40%) HAART experienced. Renal failure was less frequent among patients who were exclusively on Tenofovir (11 %; P=0.005). Factors associated with renal dysfunction in the multivariate logistic analyses included old age (aOR =21.22; 95% CI:4.00 – 112.55; p ˂ 0.001), proteinuria (aOR =3.90; 95% CI:1.90 – 8.01; p =0.001), albuminuria (aOR =3.36; 95% CI: 1.53 – 7.37; p = 0.003) and low body mass index (aOR =0.04; 95% CI:0.01 – 0.14; p ˂0.001). HAART use revealed a risk reduction of renal failure (aOR =0.35; 95% CI:0.17 – 0.79; p = 0.005).

Renal failure is high among HIV-infected persons at the Nkongsamba daycare unit and more frequent among HAART naïve patients. Proteinuria and albuminuria were observed as early markers of severe kidney dysfunction while old age and low body mass index, were identified as independent predictors. Close monitoring of renal function in patients above 55 years, early initiation on HAART of persons newly diagnosed of HIV,  use of dipstick proteinuria for early detection of renal dysfunction before HAART initiation  and the necessity to carry out a well-designed cohort to monitor the effects of tenofovir and other HAART were recommended.