Open AccessReduced renal function is associated with progression to AIDS but not with overall mortality in HIV‐infected kenyan adults not initially requiring combination antiretroviral therapy
Author(s) -
Gupta Samir K,
Ong'or Willis Owino,
Shen Changyu,
Musick Beverly,
Goldman Mitchell,
WoolsKaloustian Kara
Publication year - 2011
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1186/1758-2652-14-31
Subject(s) - medicine , renal function , interquartile range , cart , hazard ratio , proportional hazards model , creatinine , kidney disease , mortality rate , immunology , confidence interval , mechanical engineering , engineering
Background The World Health Organization (WHO) has recently recommended that antiretrovirals be initiated in all individuals with CD4 counts of less than 350 cells/mm 3 . For countries with resources too limited to expand care to all such patients, it would be of value to able to identify and target populations at highest risk of HIV progression. Renal disease has been identified as a risk factor for disease progression or death in some populations. Methods Times to meeting combination antiretroviral therapy (cART) initiation criteria (developing either a CD4 count < 200 cells/mm 3 or WHO stage 3 or 4 disease) and overall mortality were evaluated in cART‐naïve, HIV‐infected Kenyan adults with CD4 cell counts ≥200/mm 3 and with WHO stage 1 or 2 disease. Cox proportional hazard regression models were used to evaluate the associations between renal function and these endpoints. Results We analyzed data of 7383 subjects with a median follow‐up time of 59 (interquartile range, 27‐97) weeks. In Cox regression analyses adjusted for age, sex, WHO disease stage, CD4 cell count and haemoglobin, estimated creatinine clearance (CrCl) < 60 mL/min was significantly associated with shorter times to meeting cART initiation criteria (HR 1.34; 95% CI, 1.23‐1.52) and overall mortality (HR 1.73; 95% CI, 1.19‐2.51) compared with CrCl ≥60 mL/min. Estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 was associated with shorter times to meeting cART initiation criteria (HR 1.39; 95% CI, 1.22‐1.58), but not with overall mortality. CrCl and eGFR remained associated with shorter times to cART initiation criteria, but neither was associated with mortality, in weight‐adjusted analyses. Conclusions In this large natural history study, reduced renal function was strongly associated with faster HIV disease progression in adult Kenyans not initially meeting cART initiation criteria. As such, renal function measurement in resource‐limited settings may be an inexpensive method to identify those most in need of cART to prevent progression to AIDS. The initial association between reduced CrCl, but not reduced eGFR, and greater mortality was explained by the low weights in this population.