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Use of pre-ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire
P A Minchella1, C Adjé-Touré2, G Zhang1
1Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Insights
Simplifying pre-antiretroviral therapy (ART) screening in low-resource settings is feasible, as few patients exhibit conditions linked to ART toxicities. Targeted screening can balance safety and service efficiency for HIV care.
Area of Science:
- Clinical Medicine
- Public Health
- Infectious Diseases
Background:
- Health systems in low-resource settings face high demand for HIV services, necessitating resource optimization.
- Simplifying services, such as pre-antiretroviral therapy (ART) laboratory screening, can reduce the burden on these systems.
Purpose of the Study:
- To assess the frequency of conditions linked to ART toxicities in ART-naïve patients in Côte d'Ivoire.
- To identify factors associated with these conditions and evaluate the potential for simplifying pre-ART screening.
Main Methods:
- Retrospective analysis of 34,994 adult, ART-naïve patients' laboratory data from 1998-2017 in Abidjan, Côte d'Ivoire.
- Screening included tests for renal dysfunction, hepatic abnormalities, and severe anaemia.
- Analysis across four eras to identify trends and associated factors.
Main Results:
- Only 8.4% of patients presented with renal dysfunction, hepatic abnormalities, or severe anaemia.
- Prevalence of these conditions remained largely unchanged over time.
- Factors associated with renal dysfunction and severe anaemia included age >50 years and CD4 count <100 cells/µl.
Conclusions:
- The low prevalence of toxicity-related conditions supports simplifying pre-ART laboratory screening.
- Targeted screening strategies can effectively balance the detection of adverse events with service simplification in HIV care.
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.
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