Incidence of Nephropathy in HIV Infected Patients Receiving Highly Active Antiretroviral Therapy at Newlands Clinic: A Retrospective Study

Abstract

Introduction: HIV infected patients on antiretroviral therapy (ART) are at risk of developing nephropathy and therefore require monitoring of renal function. Some medications used in the management of HIV, opportunistic infections (OIs) and other comorbidities are nephrotoxic and may further compromise renal function, underlining the importance of regular monitoring of renal function. This study was designed to determine the incidence of nephropathy in HIV infected patients on antiretroviral therapy (ART) at Newlands Clinic and to determine the associated risk factors. Methodology: A retrospective cohort study was conducted involving 1986 HIV-1 infected participants who were commenced on ART between January 2007 and December 2013 at Newlands Clinic. The majority of participants were female (1340 (67.5%)). All participants were aged 18 or older at ART commencement. Participants with pre-existing nephropathy at baseline were excluded. Nephropathy was defined as two consecutive calculated creatinine clearances (CrCl) less than 60 ml/min by the Cockcroft-Gault equation, or two consecutive urine dipsticks positive for protein (≥30 g/L albumin). Data collected during routine patient visits were exported from the clinic’s database and analysed for incidence of nephropathy and risk factors. Results: During the follow-up period, 93 of the 1986 participants (4.7%) developed nephropathy. The estimated incidence rate (IR) of nephropathy was 1.45/100 person years (CI: 1.17 - 1.78). In the multivariate analysis, statistically significant risk factors were baseline age > 45 (HR 2.30, CI: 1.50 - 3.55), diabetes mellitus (HR 4.12, CI: 1.75 - 9.69), pulmonary tuberculosis (HR 2.00, CI: 1.28 - 3.12), and HIV wasting syndrome (HR 2.72, CI: 1.30 - 5.68). Conclusion: The incidence of nephropathy was low in this cohort. The traditional risk factors for renal disease; older age and diabetes mellitus were significant, as well as HIV wasting syndrome and pulmonary tuberculosis. HIV care should be complimented with proper diabetic care and patients that develop pulmonary tuberculosis, HIV wasting syndrome or are initiated on ART above 45 years require regular monitoring for early detection of nephropathy.