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Advanced renal disease, end-stage renal disease and renal death among HIV-positive individuals in Europe  [cached]
Ryom L,Kirk O,Lundgren J,Reiss P
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18136
Abstract: Many studies have focused on chronic kidney disease in HIV-positive individuals, but few have studied the less frequent events, advanced renal disease (ARD) and end-stage renal disease (ESRD). The aim of this study was to investigate incidence, predictors and outcomes for ARD/ESRD and renal death in EuroSIDA. ARD was defined as confirmed eGFR < 30 ml/min per 1.73 m2 (>3 months apart) using Cockcroft-Gault. ESRD was defined as hemo- or peritoneal dialysis>1 month/renal transplant. Renal deaths were defined as renal failure as the underlying cause of death, using CoDe methodology. Patients were followed from baseline (first eGFR after 1/1/2004) until last eGFR, ARD/ESRD/renal death; whichever occurred first. Poisson regression was used to identify predictors. 8817 persons were included, the majority were white (87.3%), males (73.9%) infected though homosexual contact (41.5%) and with a median age of 42 years (IQR 36–49). 45 persons (0.5%) developed the composite endpoint; ARD (24), ESRD (19) and renal death (2) during a median follow up (FU) of 4.5 years (IQR 2.7–5.8), incidence rate (IR) 1.21/1000 PYFU (95% CI 0.86–1.57). Of 312 persons (3.5%) with baseline eGFR<60 ml/min/1.73 m2, 13.3% (7.5–18.9) are estimated to develop ARD/ESRD/renal death within 6 years after baseline compared to 0.86% (0.58–1.1) of all patients, using Kaplan-Meier methods. Predictors in multivariate analysis were older age (IRR 1.29 per 10 years [0.95–1.75]) any cardiovascular risk (IRR 2.34 [1.23–4.45]), CD4 count (IRR 0.76 per 2-fold higher [0.60–0.97]) and eGFR (IRR 0.63 per 5 ml/min/1.73 m2 higher [0.58–0.69]). Ethnicity, gender, nadir CD4, VL, HBV and using potential nephrotoxic antiretrovirals were insignificant in uni- and multivariate analysis. At 1 year after ARD/ESRD, 23.3% (CI 9.8–36.8) were estimated to have died using Kaplan-Meier methods. The 11 deaths were from renal causes (2), non-AIDS-defining malignancies (2), hepatitis-associated liver failure (1), respiratory failure (1), cardiovascular disease (1), pancreatitis (1) and unknown causes (3). The ARD/ESRD/renal death incidence was low in this population with the available FU, and was associated with traditional and HIV-related risk factors. Most persons with ARD/ESRD/renal death had pre-existing renal impairment, but some experienced a rapid progression from initial normal levels. Prognosis after ARD/ESRD was poor. Larger studies are required to address the possible contribution of specific antiretrovirals.
Prevalence and Factors Associated with Renal Dysfunction in HIV Positive and Negative Adults at the University Teaching Hospital, in Lusaka
J Banda, A Mweemba, S Siziya, M Mweene, B Andrews, S Lakhi
Medical Journal of Zambia , 2010,
Abstract: Background: Despite having the highest disease burden of HIV, Sub-Saharan Africa has limited data on HIV related kidney disease with most available data coming from the developed countries. Kidney disease is a recognised complication in HIV infected patients presenting with acute renal failure (ARF) or chronic kidney disease (CKD). This study investigated the prevalence and risk factors associated with renal dysfunction among hospitalised HIV infected patients at the University Teaching Hospital (UTH), Lusaka. Methodology:We conducted a cross sectional study at the University Teaching Hospital Lusaka, in Zambia. Inclusion criteria were hospitalised patients aged 16years and above who consented to the study. Both HIV infected and uninfected patients were included in the study. After obtaining demographic information, study participants were screened for HIV upon their consenting for the test. Afull clinical history and examination was done by study physician to determine factors associated with renal dysfunction. Results: Of the 300 recruited hospitalised patients in this cross sectional study, 142(47%) were HIV infected. We observed a high prevalence of renal dysfunction among hospitalised HIV infected patients compared to uninfected patients (42% vs. 27%, adjusted OR 1.99, 95% CI 1.20-3.28). They had a twofold increased likelihood of developing kidney dysfunction (OR 1.96,95 CI%; 1.21-3.17). The presence of vomiting was strongly associated with renal dysfunction in both HIV positive (AOR 7.77, 95% CI 2.46-24-53) and negative (AOR4.83, 95%CI 1.40-16.66) subgroups. WHO stage III was associated with renal dysfunction in HIV infected patients. Tenofovir use, (a first line antiretroviral drug in Zambia) and hypotension were not significant factors associated with kidney disease after adjusting for other clinical parameters. Conclusion: Renal dysfunction is significantly higher among hospitalised HIV infected compared to uninfected, however tenofovir and hypotension were not associated with renal dysfunction.
Assessment of Renal Function among HIV-Infected Patients on Combination Antiretroviral Therapy at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia  [PDF]
Kassahun Eneyew, Daniel Seifu, Wondwossen Amogne, M. K. C. Menon
Technology and Investment (TI) , 2016, DOI: 10.4236/ti.2016.73013
Abstract: Background: Acquired immunodeficiency syndrome (AIDS) is a spectrum of disease states characterized by progressive immunosuppression. Sub-Saharan Africa is heavily affected by human immunodeficiency virus (HIV) and AIDS than any other region of the world. Renal complications are important component of advanced HIV disease, and these complications significantly contribute to morbidity and mortality in HIV/AIDS patients. Aim of the Study: To assess renal function abnormalities in HIV infected patients and compare with treatment-naive and HIV-negative control groups. Methods: A retrospective cross sectional study of comparative nature was designed and samples and biochemical data were collected from July 1/2012 to February 1/2013 in patients attending the ART clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Renal functions of 180 participants were assessed. The data obtained were analyzed using SPSS version 16.0. Result: A total of 180 participants grouped as HIV-negative controls (n = 60), HIV+ treatment-naive (n = 60) and HIV+ on HAART were recruited to participate in this study. Out of 180 participants included in the study, 59 (32.78%) were males and the remaining 121 (67.22%) were females. Mean serum total protein was higher in patients on HAART groups (5.78 ± 1.39) than treatment-naive (4.76 ± 2.19). There was significant reduction (p < 0.05) in serum total protein in both HIV+ groups as compared with the control groups. The mean serum creatinine level was not significantly different among three groups. The mean serum creatinine clearance in treatment-naive groups (111.05 ± 11.33) was lower than the control groups (115.05 ± 44.41) and patients on HAART (114.76 ± 28.54). There was a positive and significant correlation of glomerular filtration rate with BMI on treatment-naive groups. Conclusion: There are no statistically significant differences in the levels of Creatinine clearance and Estimated Glomerular Filtration Rate (eGFR) in HIV positive patients (naive as well as treated) as compared to the negative controls. The prevalence of renal impairment as defined by CrCl < 60 mL/min (eGFR < 60 ml/min/1.73 m2) is higher in treatment-naive participants than those on HAART and HIV-negative control groups.
Correlation of CD4 Counts with Renal Disease in HIV Positive Patients  [cached]
Janakiraman Hari,Abraham Georgi,Matthew Milly,Kuruvilla Sarah
Saudi Journal of Kidney Diseases and Transplantation , 2008,
Abstract: To correlate CD 4 counts with albuminuria and glomerular lesions in patients infected with human immunodeficiency virus (HIV), we studied 104 HIV positive patients (68 males, 36 females) of whom 100 patients were infected by heterosexual contact, 3 by transfusion, and 1 by IV drug abuse. We screened over nine months for albuminuria by urine dip stick method, and performed renal biopsy on patients with albuminuria 2+ or more. Histological examination was accomplished by light microscopy in all and by electron microscopy when it was feasible. Albuminuria was observed in 29 (27%) patients, and it revealed a significant negative correlation with CD4 count (p < 0.01). Patients with CD4 cells < 350 cells/mm [3] disclosed a 3.5 fold increased risk of albuminuria as compared with patients with CD4 > 350 cells/mm [3] . There was no significant correlation between proteinuria and the duration of infection from the time of diagnosis. Albuminuria also demonstrated a significant negative correlation with the levels of hemoglobin (p< 0.05). In addition, low numbers of CD4 cells were associated with lower levels of hemoglobin (p< 0.001). Only 10 patients received renal biopsies, and the results revealed HIV-associated nephro-pathy (HIVAN) in 7 (70%) patients, chronic tubulointerstitial nephritis in 1, membranous glome-rulopathy in 1, and diffuse proliferative glomerulonephritis in 1. Acute renal failure was present in 5 patients, of whom four had a pre renal component and one had multiorgan dysfunction syndrome. We conclude that our study demonstrates that both proteinuria and HIVAN are common in HIV infected patients. Proteinuria has a negative correlation with the CD4 counts and hemoglobin levels.
HIV Risk among MSM in Senegal: A Qualitative Rapid Assessment of the Impact of Enforcing Laws That Criminalize Same Sex Practices  [PDF]
Tonia Poteat, Daouda Diouf, Fatou Maria Drame, Marieme Ndaw, Cheikh Traore, Mandeep Dhaliwal, Chris Beyrer, Stefan Baral
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0028760
Abstract: Men who have sex with men (MSM) are at high risk for HIV in Senegal, with a prevalence of 21.5%. In December 2008, nine male HIV prevention workers were imprisoned for “acts against nature” prohibited by Senegalese law. This qualitative study assessed the impact of these arrests on HIV prevention efforts. A purposive sample of MSM in six regions of Senegal was recruited by network referral. 26 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) were conducted in July–August 2009. 14 key informants were also interviewed. All participants reported pervasive fear and hiding among MSM as a result of the December 2008 arrests and publicity. Service providers suspended HIV prevention work with MSM out of fear for their own safety. Those who continued to provide services noticed a sharp decline in MSM participation. An effective response to the HIV epidemic in Senegal should include active work to decrease enforcement of this law.
Screening for Microalbuminuria in HIV-Positive Children in Enugu  [PDF]
Ezeonwu Bertilla Uzoma,Okafor Henrietta Uchenna,Ikefuna Anthony Nnaemeka,Oguonu Tagbo
International Journal of Nephrology , 2012, DOI: 10.1155/2012/805834
Abstract: Background. Human immunodeficiency virus associated nephropathy (HIVAN) is a rapidly progressive chronic renal parenchymal disease that occurs in HIV-infected individuals and manifests commonly as proteinuria, which is preceded by microalbuminuria (MA). This clinical entity is defined as a spot urine albumin of 20–200?mg/L. Objectives. To determine the prevalence of microalbuminuria in HIV positive children in UNTH, Enugu and compare it with that of HIV-negative children. Methods. A total of 154?HIV positive children aged 18 months to 14 years and 154?HIV-negative children of corresponding attributes were screened for microalbuminuria, using Micral test II strip which has a sensitivity of 90–99%. Results. No child among the groups (HIV positive and negative) had microalbuminuria. Majority (96.0%) of HIV-positive children had nonadvanced HIV disease at the time of the study ( ). About 77.3% were using HAART ( ), the mean CD4 cell count of the subjects was cells/mm3; while 78.0% had nonsevere immunosuppression ( ). Furthermore, HIV-positive children with severe immunosuppression were younger and had shorter duration of treatment. Conclusion. Microalbuminuria may not be very common in Nigerian children irrespective of their HIV status. 1. Introduction Nigeria contributes 9% to global HIV burden, and has a seroprevalence of 4.6% with 220,000 children already living with HIV infection as of 2008 [1, 2]. Human immunodeficiency virus (HIV) affects many organs including the kidney [3]. HIV renal parenchymal disease is varied and may result from direct effect of the virus on renal epithelial cells, immune-complex mediated vasculitis, hyperviscosity of blood secondary to hyperglobulinaemia, various opportunistic infections, and also drugs [4]. The commonest chronic renal parenchymal disease in HIV-positive patients is HIV-associated nephropathy (HIVAN) [5, 6], which occurs in childhood [6–9] and has been documented in Nigerian children too [9, 10]. HIVAN progresses to ESRD but if detected early, this progression can be slowed or even halted with the use of HAART [6]. The commonest manifestation of HIVAN is proteinuria, [5, 11] which has been described in HIV-positive children [6, 9] and Esezobor and colleague [9] in Nigeria documented a prevalence of 20.5% in HIV-positive Nigerian children. Microalbuminuria is a predictor of subclinical renal involvement in systemic diseases including HIVAN [3]. It precedes proteinuria [3] and has been shown to be an early manifestation of HIVAN [3]. Therefore, the detection of microalbuminuria as well as the prompt institution
Renal dysfunction and factors associated among newly identified HIV-infected patients in Brazzaville, Republic of Congo
E Ekat,D Diafouka
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18313
Abstract: Background With the introduction of nephrotoxic in recent WHO recommendation, it became necessary to determine prevalence and factors associated with renal dysfunction among patients newly identified HIV-infected in Brazzaville. Methods Descriptive and analytical study of patients newly diagnosed HIV-infected at the Ambulatory Treatment Center in Brazzaville, Republic of Congo between January 1st, 2009 and December 31st, 2010. Estimated glomerular filtration rate (eGFR) was assessed using the Cockroft-Gault formula (CGCl) and modification of diet in renal disease (MDRD) equation. Patients had renal dysfunction mild, moderate or severe when eGFR were respectively 60–89 ml/min, 30–59 ml/min and<30 ml/min with the GCCl and MDRD. To determine factors associated with renal failure (defined as GCCl<60 ml/min), univariate analysis followed by multivariate logistic regression analysis was performed. Results We evaluated 562 patients newly identified HIV-infected, median age was 38.84 (interquartile range (IQR): 33.18–46.24) years, all patients were of African origin, 61.1% were female, median BMI was 20.30 (IQR: 17.96–22.89) kg/m2, median CD4 count was 192 (IQR: 81–350) cells/mm3 and 70.8% were at WHO stage III/IV. GFR was lower using CGCl (median 74.99 ml/min, 26.1%<60 ml/min) versus MDRD (95.59 ml/min/1.73 m2, 7.9%<60 ml/min/1.73 m2). Two hundred and fifty-seven patients (47.2%) using CGCl versus 138 (32.6%) with the MDRD had mild, 126 patients (23.1%) versus 33 (5.9%) respectively had moderate, and 16 patients (3%) versus 11 patients (2%) respectively had severe renal dysfunction. Factors associated with renal dysfunction in multivariate analysis included age superior to 40 years (adjusted odds ratio (aOR): 0.37 [95% CI: 0.22-0.61]; p=0.0001), CD4+ T-cell count below 200 cells/mm3 (aOR: 1.72 [95% CI: 1.04–2.83]; p=0.035) and BMI less than 18.5 kg/m2 (aOR: 4.39 [95% CI: 2.63–7.33]; p<0.0001). Conclusions This study shows a high prevalence of renal dysfunction in patients newly diagnosed HIV positive in Brazzaville. Necessity is now beside serum creatinine assay performed in the initial assessment as recommended by WHO, to also perform urine dipstick for better monitoring of these patients before initiating antiretroviral therapy.
Pattern of neuropsychological performance among HIV positive patients in Uganda
Kevin R Robertson, Noeline Nakasujja, Matthew Wong, Seggane Musisi, Elly Katabira, Thomas D Parsons, Allan Ronald, Ned Sacktor
BMC Neurology , 2007, DOI: 10.1186/1471-2377-7-8
Abstract: The neuropsychological test scores of 110 HIV positive patients (WHO Stage 2, n = 21; WHO Stage 3, n = 69; WHO Stage 4, n = 20) were contrasted with those of 100 control subjects on measures of attention/concentration, mental flexibility, learning/memory, and motor functioning.Analysis of covariance (ANCOVA) revealed significant group differences on measures of verbal learning and memory, speed of processing, attention and executive functioning between HIV seropositive and seronegative subjects.Ugandan patients with HIV demonstrated relative deficits on measures of verbal learning and memory, speed of processing, attention, and executive functioning compared to HIV negative controls. These results from a resource limited region where clades A and D are prevalent are consistent with previous findings in the developed world where clade B predominates.Studies done in the developed world in the era prior to highly active antiretroviral therapy (HAART) have shown prevalence rates of dementia ranging from 7.3%–27.3% in patients with advanced infection [1-3]. Despite the high prevalence of HIV in many African countries, very few studies have examined cognitive functioning in these patients. It cannot be assumed that HIV positive patients in Africa exhibit the same declines as patients in high-resource settings, since there are differences that may influence cognitive functioning including nutrition, history of concomitant disease, and varying HIV strains, among other possibilities.Cognitive impairments are relatively common in HIV infection. The most striking picture is of frank dementia. HIV associated dementia (HAD) afflicts 10–15% of patients with advanced infection in the United States [3], but there is also a high incidence of less severe dysfunction that has been labeled minor cognitive motor dysfunction (MCMD). HIV-associated cognitive impairment is found across all disease stages, with increasing rates of impairment with increasing systemic stage of HIV disease. Th
Cognitive Dysfunction among HIV Positive and HIV Negative Patients with Psychosis in Uganda  [PDF]
Noeline Nakasujja, Peter Allebeck, Hans Agren, Seggane Musisi, Elly Katabira
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0044415
Abstract: Background Cognitive impairment is an established phenomenon in HIV infected individuals and patients that have psychosis. However there is need to establish the severity of the impairment if patients are co morbid with both conditions. Aim To compare cognitive function among HIV positive individuals and HIV negative individuals with psychosis. Methods We recruited patients with psychosis at two national referral hospitals. A standardized demographics questionnaire and psychiatric, physical, and laboratory assessments were conducted. Types of psychosis were diagnosed using the Mini International Neuropsychiatric Inventory-PLUS while cognitive functioning was determined using the Mini mental state examination (MMSE) and a neuropsychological test battery. Follow-up assessments on cognitive function and severity of psychiatric illness were performed at 3 and 6 months. Pairwise comparison and multivariable logistic regression analysis were used to determine the differences between the HIV positive and HIV negative individuals. Results There were 156 HIV positive and 322 HIV negative participants. The mean age was 33 years for the HIV positive group and 29 years for the HIV negative group (p<0.001). The HIV positive individuals were almost three times (OR = 2.62 CI 95% 1.69–4.06) more likely to be cognitively impaired on the MMSE as well as the following cognitive tests:- WHO-UCLA Auditory Verbal Learning Test (OR 1.79, 95% CI 1.09–2.92), Verbal Fluency (OR 3.42, 95% CI 2.24–5.24), Color Trails 1 (OR 2.03, 95% CI 1.29–3.02) and Color Trails 2 (OR 3.50 95% 2.00–6.10) all p = 0.01. There was improvement in cognitive function at follow up; however the impairment remained higher for the HIV positive group (p<0.001). Conclusion Cognitive impairment in psychosis was worsened by HIV infection. Care plans to minimize the effect of this impairment should be structured for the management of individuals with HIV and psychosis.
An update on immunosuppression for the HIV-positive kidney transplant recipient
Natário,Ana; Matias,Patrícia; Weigert,André;
Portuguese Journal of Nephrology & Hypertension , 2012,
Abstract: the outcome of human immunodeficiency virus (hiv)-positive patients has improved dramatically with the advent of combined antiretroviral therapy. the mortality rate for hiv-positive patients with chronic kidney disease stage 5 is now similar to those without hiv infection, making kidney transplantation an increasingly considered alternative treatment for end-stage renal disease in this population. knowledge of the pharmacokinetics of antiretroviral medications and potential drug-drug interactions between antiretroviral and immunosuppressive medications are critical to the success of transplantation in this setting. the aim of this article is to present the state of the art kidney transplant therapy in hiv-positive patients.
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