Factors Associated with Chronic Kidney Disease in Patients Living with HIV in Yamoussoukro (Ivory Coast)

Abstract

Introduction: Human immunodeficiency virus (HIV) infection is an epidemic in sub-Saharan Africa and is a risk factor for kidney disease. The aim of this study was to assess the prevalence of chronic kidney disease (CKD) in patients living with HIV (PLHIV) in Yamoussoukro and to identify associated factors. Methods: This was a cross-sectional analytical study conducted at the Walè Medical and Social Centre in Yamoussoukro from 4 January to 31 July 2021. The study involved people living with HIV, aged at least 18 years, on Highly active antiretroviral therapy (HAART) protocol, without glomerular filtration rate (GFR) or urine sediment abnormalities, with a complete medical record and having given informed consent. CKD was defined as GFR < 60 ml/min/1.73m 2 , and/or albuminuria ≥ 30 mg/gCr observed on two assays spaced at least 3 months apart. Data were analysed using Epi-Info software. Results: Of the 174 PLHIV included, 46 were men and 128 were women, giving a sex ratio of 0.4. The mean age was 46.5 years (extremes 19 and 74 years). The majority (96.6%) were infected with HIV-1. The patients were at stage B2 in 36.2% of cases and the mean CD 4 count was 622 cells/ mm3. The first-line treatment regimen included tenofovir disoproxil fumarate (TDF) in 94.3% (164/174). At inclusion, 15 patients (8.6%) had a GFR < 60 ml/min and 52 patients (29.9%) had an ACR) ≥ 30 mg/gCr. At month 3 control, 11 patients (6.3%) had a GFR < 60 ml/min, and 52 (29.9%) had an ACR ≥ 30 mg/gCr. CKD was present in 46 (26.4%) cases. The occurrence of CKD was associated with the presence of high blood pressure (P = 0.014) and would be associated with the use of tenofovir -based therapeutic protocols (P = 0.004). Conclusion: CKD is relatively common in people living with HIV. Early detection is essential in the follow-up of infected patients. We recommend that all PLHIV on HAART be screened for renal abnormalities by measuring blood pressure and creatinine levels, estimating GFR, looking for proteinuria and careful choice of antiretrovirals, and proactive management of comorbidities.