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Use of pre‐ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire
Author(s) -
Minchella P. A.,
AdjéTouré C.,
Zhang G.,
Tehe A.,
Hedje J.,
Rottinghaus E. R.,
Natacha K.,
Diallo K.,
Ouedraogo G. L.,
Nkengasong J. N.
Publication year - 2020
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.13364
Subject(s) - medicine , renal function , creatinine , confidence interval , odds ratio , cote d ivoire , alanine aminotransferase , gastroenterology , pediatrics , philosophy , humanities
Background High demand for HIV‐services and extensive clinical guidelines force health systems in low‐resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre‐antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification. Methods We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART‐naïve patients with specimens referred to the RETRO‐CI laboratory in Abidjan, Côte d’Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT) and haemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate < 50 mL/min), hepatic abnormalities (ALT > 5× upper limit of normal) and severe anaemia (Hb < 6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question. Results The prevalence of renal dysfunction, hepatic abnormalities and severe anaemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anaemia were age > 50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19–2.92; P < 0.001) and CD4 < 100 cells/µl (aOR: 2.57; 95% CI: 2.30–2.88; P < 0.001). Conclusion The relative infrequency of conditions linked to toxicity in Côte d’Ivoire supports the notion that simplification of pre‐ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.