Open AccessRenal dysfunction and factors associated among newly identified HIV‐infected patients in Brazzaville, Republic of Congo
Author(s) -
Ekat E,
Diafouka D
Publication year - 2012
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 - 10.7448/ias.15.6.18313
Subject(s) - medicine , interquartile range , renal function , univariate analysis , logistic regression , urology , human immunodeficiency virus (hiv) , creatinine , gastroenterology , multivariate analysis , immunology
With the introduction of nephrotoxic in recent WHO recommendation, it became necessary to determine prevalence and factors associated with renal dysfunction among patients newly identified HIV‐infected in Brazzaville. Methods Descriptive and analytical study of patients newly diagnosed HIV‐infected at the Ambulatory Treatment Center in Brazzaville, Republic of Congo between January 1st, 2009 and December 31st, 2010. Estimated glomerular filtration rate (eGFR) was assessed using the Cockroft‐Gault formula (CGCl) and modification of diet in renal disease (MDRD) equation. Patients had renal dysfunction mild, moderate or severe when eGFR were respectively 60–89 ml/min, 30–59 ml/min and<30 ml/min with the GCCl and MDRD. To determine factors associated with renal failure (defined as GCCl<60 ml/min), univariate analysis followed by multivariate logistic regression analysis was performed. Results We evaluated 562 patients newly identified HIV‐infected, median age was 38.84 (interquartile range (IQR): 33.18–46.24) years, all patients were of African origin, 61.1% were female, median BMI was 20.30 (IQR: 17.96–22.89) kg/m 2 , median CD4 count was 192 (IQR: 81–350) cells/mm 3 and 70.8% were at WHO stage III/IV. GFR was lower using CGCl (median 74.99 ml/min, 26.1%<60 ml/min) versus MDRD (95.59 ml/min/1.73 m 2 , 7.9%<60 ml/min/1.73 m 2 ). Two hundred and fifty‐seven patients (47.2%) using CGCl versus 138 (32.6%) with the MDRD had mild, 126 patients (23.1%) versus 33 (5.9%) respectively had moderate, and 16 patients (3%) versus 11 patients (2%) respectively had severe renal dysfunction. Factors associated with renal dysfunction in multivariate analysis included age superior to 40 years (adjusted odds ratio (aOR): 0.37 [95% CI: 0.22‐0.61]; p=0.0001), CD4+ T‐cell count below 200 cells/mm 3 (aOR: 1.72 [95% CI: 1.04–2.83]; p=0.035) and BMI less than 18.5 kg/m 2 (aOR: 4.39 [95% CI: 2.63–7.33]; p<0.0001). Conclusions This study shows a high prevalence of renal dysfunction in patients newly diagnosed HIV positive in Brazzaville. Necessity is now beside serum creatinine assay performed in the initial assessment as recommended by WHO, to also perform urine dipstick for better monitoring of these patients before initiating antiretroviral therapy.