Renal dysfunction among anti-retroviral therapy naïve HIV infected patients in Zimbabwe

The prevalence and determinants of renal dysfunction among HIV infected adults in the outpatient in Zimbabwe setting is unknown.

To determine the proportion of patients with evidence of renal dysfunction among anti-retroviral treatment naive HIV infected patients in a tertiary outpatient setting.

Cross sectional study.

HIV outpatients' clinic (Family Care Centre) at Parirenyatwa hospital.

159 Anti-retroviral therapy (ART) naive HIV infected adults.

A cross-sectional study was carried out on ART-naive HIV infected willing adult participants, > or = 18 years old. WHO clinical staging was conducted on all participants. Urine was examined using urinary dipsticks and proteinuria quantification by calculating its protein: creatinine ratio. Serum creatinine and CD4 cell counts were measured. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault formula.

The primary endpoint was renal dysfunction defined as CrCl < 60 ml/min. Protenuria, defined as > or = + dipstick positive and/or protein to creatinine ratio > 20 mg/mg was a secondary outcome.

Renal dysfunction defined as CrCl < 60 ml/min was found in 7.5% [95% CI 3.4-11.7] (12/159) of the participants. Risk factors for renal dysfunction were age [OR 1.14, (95% CI 1.06-1.22)], BMI [OR 0.77 (95% CI 0.61-0.94)] andproteinuria [OR 7.45 (95% CI 1.58-35.26)]. Proteinuria was common, occurring in 45.9% of the participants.

[corrected] A high prevalence of proteinuria (45.9%) was found in this study, while the prevalence of reduced creatinine clearance was relatively low (7.5%). Screening for proteinuria is strongly recommended in ART naive HIV infected patients and should be complemented by measurement of serum creatinine and calculation ofcreatinine clearance.