We determined the prevalence of renal impairment and possible HIV-associated nephropathy (HIVAN) in adults with World Health Organization (WHO) stages I or II HIV, presenting to the antiretroviral therapy (ART) clinic in a central hospital in Malawi. We enrolled 526 ART-naïve subjects, 67% women, median age 34 (17-73) years and mean CD4 count 305 (3-993) cells/μL. Blood pressure, weight, urine dipstick and microscopy, CD4 cell count and serum creatinine were measured. Creatinine clearance (CrCL) was estimated using the Cockcroft-Gault equation. Possible HIVAN was diagnosed based on levels of proteinuria and CrCl. In all, 23.3% had proteinuria (≥1+). 57.4% had reduced CrCl (<90 mL/minute): 18.8% had moderate (CrCl 30-59 mL/minute) and 2.2% severe (CrCl <30 mL/minute) renal dysfunction. Extrapolating from renal biopsy studies that confirmed HIVAN, the proportion of patients with HIVAN in our clinic ranges from 1.8-21.2%. We conclude that renal impairment was common, though rarely severe, among HIV-infected adults with clinically non-advanced HIV disease. Renal dysfunction has been demonstrated to be a risk factor for (early) mortality. These results are relevant for ART programmes, such as those in Malawi, where renal function is not routinely assessed.

Additional Metadata
Keywords Epidemiology, Glomerular filtration rate, HIV, HIV-associated nephropathy, Malawi, Renal insufficiency
Persistent URL dx.doi.org/10.1258/ijsa.2011.010521, hdl.handle.net/1765/31241
Citation
Struik, G.M., den Exter, R.D., Munthali, C., Chipeta, D., van Oosterhout, J.J.G., Nouwen, J.L., & Allain, T.J.. (2011). The prevalence of renal impairment among adults with early hiv disease in blantyre, malawi. International Journal of STD & AIDS, 22(8), 457–462. doi:10.1258/ijsa.2011.010521