Faible indice de masse corporelle et impact des antirétroviraux sur la néphrotoxicité, la maladie rénale chronique chez les patients infectés par le VIH à Brazzaville,Congo |
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| Affiliation: | 1. Centre de traitement ambulatoire de Brazzaville, enceinte CHU de Brazzaville, BP 6002, Brazzaville, Congo;2. Service des maladies infectieuses et tropicales, CHNU de Fann, BP 5035, Dakar, Sénégal;3. Service des maladies infectieuses, CHU de Brazzaville, BP 1846, Brazzaville, Congo;1. Population Council, Washington, DC 20008, USA;2. Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;1. Service de pneumologie et réanimation, Assistance publique-hôpitaux de Paris, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France;2. Équipe de recherche 2 et GRC-UPMC 04 Théranoscan, université Pierre-et-Marie-Curie, université Paris-VI, 75006 Paris, France;1. Institut de la nutrition, de l’alimentation et des technologies agro-alimentaires (INATAA), université Frères-Mentouri-Constantine 1, route de Aïn-El-Bey, 25000 Constantine, Algérie;2. Laboratoire de recherche d’ALimentation, NUTrition et Santé (ALNUTS), Constantine, Algérie;3. Équipe de recherche en épidémiologie nutritionnelle, centre de recherche en épidémiologie et statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, université Paris 13, 93017 Bobigny, France;4. Environment and health, department of public health and primary care, KU Leuven, university of Leuven, Leuven, Belgique;5. Laboratory of anthropogenetics, Vrije Universiteit Brussel, Brussel, Belgique;6. Laboratoire ALimentation, NUTrition et Santé, faculté de médecine, université Salah-Boubnider, Constantine 3, Algérie;1. Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain;2. Social and Cardiovascular Epidemiology Research Group, Universidad de Alcalá, Madrid, Spain;3. Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain;4. Department of Biochemistry-Research, Hospital Universitario Ramón y Cajal, Madrid, Spain;5. Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain |
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| Abstract: | ObjectiveTo describe the incidence and risks factors of ART induced nephrotoxicity and chronic kidney disease in HIV-1-infected adults with low body mass index (<18.5 kg/m2).MethodsA retrospective cohort study at the Ambulatory Treatment Center in Brazzaville, Congo. Patients with estimated glomerular filtration rate decrease by 25% compared to baseline or a 0.5 mg/dL increase in serum creatinine above baseline were classified as having nephrotoxicity, and chronic kidney disease was defined as a value less than 60 mL/min/1.73 m2. We used Cox proportional hazards regression models to determine factors associated with nephrotoxicity and chronic kidney disease.ResultsOf 325 patients, 73.23% were women. Median values were an age 37.55 years (IQR: 33.51–44.96), weight 45 kg (IQR: 41–49), CD4 count 137.5 cells/μL (42–245). In the first 24–months, follow-up on ART incidence rate of nephrotoxicity and chronic kidney disease was 27.95 and 7.44 per 100 persons-year respectively. Multivariate analysis identified as a risk factor of nephrotoxicity, baseline haemoglobin below or equal 8 g/dL (aHR = 2.25; 95%CI 1.28–3.98; P = 0.005) and the use of tenofovir (aHR = 1.51; 95%CI 1.01–2.27; P = 0.04). DFG between 60-80 mL/min/1.73 m2 (aHR = 0.35; 95%CI 0.21–0.59; P < 0.001) and 45-59 mL/min/1.73 m2 (aHR = 0.10; 95%CI 0.01–0.72; P = 0.02) was not a contraindication for initiating antiretroviral therapy. Each 10-year older age was associated with an increased risk of developing chronic kidney disease (aHR = 1.95; 95%CI 1.2–3.17; P = 0.007).ConclusionIncidence of nephrotoxicity and chronic kidney disease were high. African HIV-positive patient with low body mass index at baseline need close monitoring of their renal function when treated with tenofovir. |
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| Keywords: | Antiretroviral therapy Body mass index Brazzaville Congo HIV Nephrotoxicity |
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