Abstract:

Background: Prevalence of renal dysfunction has been shown to be very high in HV positive adults initiating ART worldwide. The impact of ART on renal dysfunction is not very clear as some studies document benefit while others show no benefit on renal function.

Objectives: To determine the status of renal function is a cohort of HIV infected adults screened for renal dysfunction at the time of initiating ART and attending Bugando CTC after being on ART for over one year.

Materials and Methods: A retrospective cohort study was performed among HIV-positive adults screened for renal dysfunction for mid-November 2009 through February 2010. Patients were interviewed through designed questionnaires. Spot urine for proteinuria and microalbuminuria, CD4 cell count and serum creatinine were done to all patients. Both CG and MDRD equations were used to calculate eGFR.

Results: Out of the 355 patients enrolled in the study at the time of ART initiation, 66 did not have baseline information (unknown status), 17 had died, 32 were lost to follow up, 51 were transferred out and 189 were actively following up at the CTC. Prevalence of moderate to severe renal dysfunction was found in 5.3% of the patients at follow up compared to 29% at the time of ART initiation. Median serum creatinine decreased by 18.2umol/l, a decrease of (22.8%) from baseline, while the median eGFR rose from 72.7ml/min/1.73m2 to 103.4ml/min/1.73m2 (an increase of 42%). The improvement was independent of the first line regimen used. Improvement was significantly associated with the baseline renal dysfunction.

Conclusion and Recommendations: Renal dysfunction was common in this cohort of HIV positive adults initiating ART, but significantly improved after a median follow up of 2 years on ART. This underscores the need for early screening and initiation of ART in this population improve their outcome.