XVIII International AIDS Conference


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Prevalence and risk factors associated with renal dysfunction in HIV-positive individuals on HAART

A. Menezes, J. Torelly, E. Sprinz

Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

Background: Renal impairment is increasingly reported in individuals on antiretroviral therapy (ART). Our objective is to determine the prevalence and associated risk factors of renal dysfunction in a cohort of HIV-positive individuals with undetectable HIV viral load on ART.
Methods: Individuals within 18 and 72 years old, on ART greater than 1 year, with undetectable viral load (< 50 copies/ml) and CD4 count ≥ 200 cells/mm³, are being enrolled at the outpatient HIV/AIDS clinic at Hospital de Clínicas de Porto Alegre. Exclusion criteria were HCV/HBV coinfection, pregnancy, active infection or previous diagnosis of renal disease. Renal function was estimated through the Cockcroft-Gault and MDRD and was further classified as normal (>90ml/min), mild (between 60-89ml/min), moderated (between 30-59ml/min), or severe dysfunction (between 15-29 ml/min), and renal failure or dialysis (< 15ml/min). Chi-square test and Poisson regression model were used.
Results: 196 patients (52% women) had the data analyzed so far. Average age of 45 (22-72) years old. Renal function was normal in 62% (n=122); mild impairment in 29% (n=57); moderated in 8% (n=16); and, severe in 0.5% (n=1). Serum creatinine was not a good marker of renal function. After multivariate analysis euro-descendents (RR=2.5; p=0.049; IC95%, 1.0-6.3) and increased age (RR=1.05; p=0.01; IC95%,1.02-1.07) were associated with reduction in renal function (clearance < 90 ml/min). For those with clearance < 60ml/min, associated risk factors were the use of ritonavir alone (RR=4.4; p=0.04; IC95%,1.1-17.7); ritonavir with tenofovir (RR=5.6; p= 0.02; IC95%,1.4-22.4); and, increased age (RR=1.1; p=0.01; IC95%;1.04-1.2).
Conclusions: In this interim analysis we found a surprisingly high prevalence of renal failure: 38% with < 90ml/min and 9% with < 60ml/min. Euro-descendents and increased age were associated with mild dysfunction; while the use of ritonavir with or without tenofovir and increased age, again, were associated with further renal impairment.

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