Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania
Ritonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa. Using data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we a...
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| Veröffentlicht in: | PloS one 2021-12, Vol.16 (12), p.e0261367-e0261367 |
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| creator | Mapesi, Herry Okuma, James Franzeck, Fabian Wilson, Herieth Ismael Senkoro, Elizabeth Byakuzana, Theonestina Ndege, Robert Vanobberghen, Fiona Glass, Tracy Renée Battegay, Manuel Weisser, Maja Paris, Daniel Henry |
| description | Ritonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa.
Using data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate |
| doi_str_mv | 10.1371/journal.pone.0261367 |
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Using data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate <60 mL/min/1.73m2) at the time of switch from first-line antiretroviral treatment (ART) to bPI-regimen and the incidence of renal impairment on bPI. We assessed risk factors for renal impairment using logistic and Cox regression models.
Renal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6-5.1) years (incidence 22/1,000 person-years (95%CI 16.1-29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15-2.11), body mass index (BMI) <18.5 kg/m2 (aOR 2.80 versus ≥18kg/m2; 95%CI 1.28-6.14) and arterial hypertension (aOR 2.33; 95%CI 1.03-5.28). The risk of renal impairment was lower with increased duration of ART use (aOR 0.78 per one-year increase; 95%CI 0.67-0.91). The renal impairment incidence under bPI was associated with older age (adjusted hazard ratio 2.01 per 10 years; 95%CI 1.46-2.78).
In PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0261367</identifier><identifier>PMID: 34910776</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Age ; Anti-HIV Agents - therapeutic use ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Body mass ; Body mass index ; Body size ; Care and treatment ; Chronic illnesses ; Cohort Studies ; Complications and side effects ; Creatinine ; Epidemiology ; Female ; Glomerular filtration rate ; Glomerular Filtration Rate - physiology ; Highly active antiretroviral therapy ; HIV ; HIV infection ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Infections - genetics ; HIV Protease Inhibitors - adverse effects ; HIV Protease Inhibitors - therapeutic use ; HIV-1 - metabolism ; HIV-1 - pathogenicity ; Hospitals ; Human immunodeficiency virus ; Humans ; Hypertension ; Immunology ; Impairment ; Incidence ; Infectious diseases ; Kidney diseases ; Laboratories ; Male ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Patient outcomes ; Prevalence ; Prospective Studies ; Protease ; Protease inhibitors ; Proteinase inhibitors ; Public health ; Regression analysis ; Regression models ; Renal function ; Renal Insufficiency - etiology ; Renal Insufficiency - virology ; Risk analysis ; Risk Factors ; Ritonavir ; Rural Population ; Tanzania - epidemiology ; Tuberculosis</subject><ispartof>PloS one, 2021-12, Vol.16 (12), p.e0261367-e0261367</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Mapesi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Mapesi et al 2021 Mapesi et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-bfb87be224351ad6f2c68ad9059d1bbe1598bd974d856e769108b065c87265be3</citedby><cites>FETCH-LOGICAL-c692t-bfb87be224351ad6f2c68ad9059d1bbe1598bd974d856e769108b065c87265be3</cites><orcidid>0000-0001-7753-464X ; 0000-0003-4743-5987</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8673654/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8673654/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23865,27923,27924,53790,53792,79371,79372</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34910776$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Cohen, Karen</contributor><creatorcontrib>Mapesi, Herry</creatorcontrib><creatorcontrib>Okuma, James</creatorcontrib><creatorcontrib>Franzeck, Fabian</creatorcontrib><creatorcontrib>Wilson, Herieth Ismael</creatorcontrib><creatorcontrib>Senkoro, Elizabeth</creatorcontrib><creatorcontrib>Byakuzana, Theonestina</creatorcontrib><creatorcontrib>Ndege, Robert</creatorcontrib><creatorcontrib>Vanobberghen, Fiona</creatorcontrib><creatorcontrib>Glass, Tracy Renée</creatorcontrib><creatorcontrib>Battegay, Manuel</creatorcontrib><creatorcontrib>Weisser, Maja</creatorcontrib><creatorcontrib>Paris, Daniel Henry</creatorcontrib><creatorcontrib>KIULARCO Study Group</creatorcontrib><creatorcontrib>on behalf of the KIULARCO Study Group</creatorcontrib><title>Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Ritonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa.
Using data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate <60 mL/min/1.73m2) at the time of switch from first-line antiretroviral treatment (ART) to bPI-regimen and the incidence of renal impairment on bPI. We assessed risk factors for renal impairment using logistic and Cox regression models.
Renal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6-5.1) years (incidence 22/1,000 person-years (95%CI 16.1-29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15-2.11), body mass index (BMI) <18.5 kg/m2 (aOR 2.80 versus ≥18kg/m2; 95%CI 1.28-6.14) and arterial hypertension (aOR 2.33; 95%CI 1.03-5.28). The risk of renal impairment was lower with increased duration of ART use (aOR 0.78 per one-year increase; 95%CI 0.67-0.91). The renal impairment incidence under bPI was associated with older age (adjusted hazard ratio 2.01 per 10 years; 95%CI 1.46-2.78).
In PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.</description><subject>Adult</subject><subject>Age</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Care and treatment</subject><subject>Chronic illnesses</subject><subject>Cohort Studies</subject><subject>Complications and side effects</subject><subject>Creatinine</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Glomerular filtration rate</subject><subject>Glomerular Filtration Rate - physiology</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV infection</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - genetics</subject><subject>HIV Protease Inhibitors - adverse effects</subject><subject>HIV Protease Inhibitors - therapeutic use</subject><subject>HIV-1 - metabolism</subject><subject>HIV-1 - pathogenicity</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Immunology</subject><subject>Impairment</subject><subject>Incidence</subject><subject>Infectious diseases</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patient outcomes</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Protease</subject><subject>Protease inhibitors</subject><subject>Proteinase inhibitors</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Renal function</subject><subject>Renal Insufficiency - etiology</subject><subject>Renal Insufficiency - virology</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Ritonavir</subject><subject>Rural Population</subject><subject>Tanzania - epidemiology</subject><subject>Tuberculosis</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11rFDEUhgdRbK3-A9EBQRTcNTPJJJMboRS1C4WK1t6GfJzZTZlNpsnM-oE_3mx3WnakF5KLCZnnfU_yJifLnhdoXmBWvL_yQ3CynXfewRyVtMCUPcgOC47LGS0Rfrg3P8iexHiFUIVrSh9nB5jwAjFGD7M_XwJsZAtOw7vcOm3NdppLZ_IugLG69yHmvskDpGK5XXfShjW4PsF5ByF6F_Mftl_lp4vLBGmwG-uWSex7kBFm1q2ssjcuSRGGkFwupPstnZVPs0eNbCM8G79H2fdPHy9OTmdn558XJ8dnM0152c9Uo2qmoCwJrgppaFNqWkvDUcVNoRQUFa-V4YyYuqLAaDpbrRCtdM1KWinAR9nLnW_X-ijG4KJImSHMESEoEYsdYby8El2waxl-CS-tuFnwYSlk6K1uQZDKECIlKFCK1JjVhHJeS4mp5Jhrlbw-jNUGtQajU1jp0BPT6R9nV2LpN6KmDNOKJIM3o0Hw1wPEXqxt1NC20oEfdvvmaZQsoa_-Qe8_3Ugt000L6xqf6uqtqTimdcq4ZMXWa34PlYaBtdXplTU2rU8EbyeCxPTws1_KIUax-Pb1_9nzyyn7eo9dgWz7VfTt0Nv02KYg2YE6-BgDNHchF0hsm-Q2DbFtEjE2SZK92L-gO9FtV-C_et8N7Q</recordid><startdate>20211215</startdate><enddate>20211215</enddate><creator>Mapesi, Herry</creator><creator>Okuma, James</creator><creator>Franzeck, Fabian</creator><creator>Wilson, Herieth Ismael</creator><creator>Senkoro, Elizabeth</creator><creator>Byakuzana, Theonestina</creator><creator>Ndege, Robert</creator><creator>Vanobberghen, Fiona</creator><creator>Glass, Tracy Renée</creator><creator>Battegay, Manuel</creator><creator>Weisser, Maja</creator><creator>Paris, Daniel Henry</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-7753-464X</orcidid><orcidid>https://orcid.org/0000-0003-4743-5987</orcidid></search><sort><creationdate>20211215</creationdate><title>Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania</title><author>Mapesi, Herry ; Okuma, James ; Franzeck, Fabian ; Wilson, Herieth Ismael ; Senkoro, Elizabeth ; Byakuzana, Theonestina ; Ndege, Robert ; Vanobberghen, Fiona ; Glass, Tracy Renée ; Battegay, Manuel ; Weisser, Maja ; Paris, Daniel Henry</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-bfb87be224351ad6f2c68ad9059d1bbe1598bd974d856e769108b065c87265be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Age</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Anti-Retroviral Agents - therapeutic use</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>Biology and Life Sciences</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Care and treatment</topic><topic>Chronic illnesses</topic><topic>Cohort Studies</topic><topic>Complications and side effects</topic><topic>Creatinine</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Glomerular filtration rate</topic><topic>Glomerular Filtration Rate - physiology</topic><topic>Highly active antiretroviral therapy</topic><topic>HIV</topic><topic>HIV infection</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - genetics</topic><topic>HIV Protease Inhibitors - adverse effects</topic><topic>HIV Protease Inhibitors - therapeutic use</topic><topic>HIV-1 - metabolism</topic><topic>HIV-1 - pathogenicity</topic><topic>Hospitals</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Immunology</topic><topic>Impairment</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Kidney diseases</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patient outcomes</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Protease</topic><topic>Protease inhibitors</topic><topic>Proteinase inhibitors</topic><topic>Public health</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Renal function</topic><topic>Renal Insufficiency - etiology</topic><topic>Renal Insufficiency - virology</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Ritonavir</topic><topic>Rural Population</topic><topic>Tanzania - epidemiology</topic><topic>Tuberculosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mapesi, Herry</creatorcontrib><creatorcontrib>Okuma, James</creatorcontrib><creatorcontrib>Franzeck, Fabian</creatorcontrib><creatorcontrib>Wilson, Herieth Ismael</creatorcontrib><creatorcontrib>Senkoro, Elizabeth</creatorcontrib><creatorcontrib>Byakuzana, Theonestina</creatorcontrib><creatorcontrib>Ndege, Robert</creatorcontrib><creatorcontrib>Vanobberghen, Fiona</creatorcontrib><creatorcontrib>Glass, Tracy Renée</creatorcontrib><creatorcontrib>Battegay, Manuel</creatorcontrib><creatorcontrib>Weisser, Maja</creatorcontrib><creatorcontrib>Paris, Daniel Henry</creatorcontrib><creatorcontrib>KIULARCO Study Group</creatorcontrib><creatorcontrib>on behalf of the KIULARCO Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mapesi, Herry</au><au>Okuma, James</au><au>Franzeck, Fabian</au><au>Wilson, Herieth Ismael</au><au>Senkoro, Elizabeth</au><au>Byakuzana, Theonestina</au><au>Ndege, Robert</au><au>Vanobberghen, Fiona</au><au>Glass, Tracy Renée</au><au>Battegay, Manuel</au><au>Weisser, Maja</au><au>Paris, Daniel Henry</au><au>Cohen, Karen</au><aucorp>KIULARCO Study Group</aucorp><aucorp>on behalf of the KIULARCO Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-12-15</date><risdate>2021</risdate><volume>16</volume><issue>12</issue><spage>e0261367</spage><epage>e0261367</epage><pages>e0261367-e0261367</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Ritonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa.
Using data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate <60 mL/min/1.73m2) at the time of switch from first-line antiretroviral treatment (ART) to bPI-regimen and the incidence of renal impairment on bPI. We assessed risk factors for renal impairment using logistic and Cox regression models.
Renal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6-5.1) years (incidence 22/1,000 person-years (95%CI 16.1-29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15-2.11), body mass index (BMI) <18.5 kg/m2 (aOR 2.80 versus ≥18kg/m2; 95%CI 1.28-6.14) and arterial hypertension (aOR 2.33; 95%CI 1.03-5.28). The risk of renal impairment was lower with increased duration of ART use (aOR 0.78 per one-year increase; 95%CI 0.67-0.91). The renal impairment incidence under bPI was associated with older age (adjusted hazard ratio 2.01 per 10 years; 95%CI 1.46-2.78).
In PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34910776</pmid><doi>10.1371/journal.pone.0261367</doi><tpages>e0261367</tpages><orcidid>https://orcid.org/0000-0001-7753-464X</orcidid><orcidid>https://orcid.org/0000-0003-4743-5987</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-12, Vol.16 (12), p.e0261367-e0261367 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2610390440 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Age Anti-HIV Agents - therapeutic use Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Body mass Body mass index Body size Care and treatment Chronic illnesses Cohort Studies Complications and side effects Creatinine Epidemiology Female Glomerular filtration rate Glomerular Filtration Rate - physiology Highly active antiretroviral therapy HIV HIV infection HIV Infections - complications HIV Infections - drug therapy HIV Infections - genetics HIV Protease Inhibitors - adverse effects HIV Protease Inhibitors - therapeutic use HIV-1 - metabolism HIV-1 - pathogenicity Hospitals Human immunodeficiency virus Humans Hypertension Immunology Impairment Incidence Infectious diseases Kidney diseases Laboratories Male Medicine and Health Sciences Middle Aged Mortality Patient outcomes Prevalence Prospective Studies Protease Protease inhibitors Proteinase inhibitors Public health Regression analysis Regression models Renal function Renal Insufficiency - etiology Renal Insufficiency - virology Risk analysis Risk Factors Ritonavir Rural Population Tanzania - epidemiology Tuberculosis |
| title | Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania |
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