Renal dysfunction by baseline CD CD 4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD CD 4 count in the HIV Prevention Trials Network 071 [ HPTN 071 HPTN 071 ; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (Pop ART ART )] study in South Africa

摘要

Objectives Renal dysfunction is a significant cause of morbidity and mortality among HIV ‐positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment ( ART ) regardless of CD 4 count at three Department of Health ( DOH ) clinics included in the HIV Prevention Trials Network 071 ( HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. Methods A retrospective cohort analysis of routine data for HIV ‐positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate ( eEGFR ) ?60?mL/min after ART initiation among individuals with a baseline (pre‐ ART ) eGFR ?≥?60?mL/min. Results Overall, 2423 individuals, with a median baseline CD 4 count of 328?cells/μL [interquartile?range ( IQR ) 195–468 cells/μL], were included in the analysis. Forty‐seven?individuals had a baseline eGFR ?60?mL/min. Among 1634 nonpregnant individuals started on a tenofovir‐containing ART regimen and with a baseline eGFR ?≥?60?mL/min, 27 developed an eGFR ?60?mL/min on ART . Regression analysis showed lower odds of baseline eGFR 60?mL/min at baseline CD 4 counts of ?500?cells/μL [adjusted odds ratio ( aOR ) 0.29; 95% confidence interval ( CI ) 0.11–0.80], 351–500?cells/μL ( aOR 0.22; 95% CI 0.08–0.59) and 201–350 ( aOR 0.48; 95% CI : 0.24–0.97) compared with baseline CD 4 counts ?200?cells/μL. Conclusions This study showed low rates of renal dysfunction at baseline and on ART , with lower rates of baseline renal dysfunction among individuals with baseline CD 4 counts??200?cells/μL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.