Premium
Low prevalence of renal dysfunction in HIV ‐infected pregnant women: implications for guidelines for the prevention of mother‐to‐child transmission of HIV
Author(s) -
Myer Landon,
Kamkuemah Monika,
Kaplan Richard,
Bekker LindaGail
Publication year - 2013
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12194
Subject(s) - medicine , creatinine , renal function , pregnancy , regimen , nephrotoxicity , kidney disease , viral load , obstetrics , human immunodeficiency virus (hiv) , immunology , kidney , genetics , biology
Objective Emerging international guidelines for the prevention of mother‐to‐child transmission of HIV infection across sub‐ S aharan A frica call for the initiation of a triple‐drug antiretroviral regimen containing tenofovir, a potentially nephrotoxic agent, in all HIV ‐infected pregnant women at the first antenatal clinic visit. While there are significant benefits to the rapid initiation of antiretroviral therapy ( ART ) in pregnancy, there are few data on the prevalence of pre‐existing renal disease in HIV ‐infected pregnant women and in turn, the potential risks of this approach are not well understood. Methods We analysed data on renal function in consecutive patients eligible for ART at a large primary healthcare clinic in C ape T own. All individuals were screened for renal dysfunction via serum creatinine and estimation of creatinine clearance via the C ockroft– G ault equation. Results Over a 2‐year period, 238 pregnant women, 1014 non‐pregnant women and 609 men were screened to initiate ART . Pregnant women eligible were significantly younger, in earlier stages of HIV disease, had higher CD 4 cell counts and lower HIV viral loads, than non‐pregnant adults. The median serum creatinine in pregnant women (46 µmol/L) was significantly lower and the median creatinine clearance (163 ml/min/1.73 m 2 ) was significantly higher than other groups ( P < 0.001 and P = 0.004, respectively). Fewer than 1% of pregnant women had moderate renal dysfunction before ART initiation, with no instances of severe dysfunction observed, compared to 7% moderate or severe renal dysfunction in non‐pregnant women or men ( P < 0.001). Conclusion Renal dysfunction in HIV ‐infected pregnant women is significantly less common than in other HIV ‐infected adults eligible for ART . The risks associated with initiating tenofovir immediately in pregnant women before reviewing serum creatinine results may be limited, and the benefits of rapid ART initiation in pregnancy may outweigh possible risks of nephrotoxicity.