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.

Epidemiology, Glomerular filtration rate, HIV, HIV-associated nephropathy, Malawi, Renal insufficiency
dx.doi.org/10.1258/ijsa.2011.010521, hdl.handle.net/1765/31241
International Journal of STD & AIDS
Erasmus MC: University Medical Center Rotterdam

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