Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania

PLoS One. 2021 Dec 15;16(12):e0261367. doi: 10.1371/journal.pone.0261367. eCollection 2021.

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Anti-Retroviral Agents / therapeutic use
  • Cohort Studies
  • Female
  • Glomerular Filtration Rate / physiology
  • 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
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Renal Insufficiency / etiology*
  • Renal Insufficiency / virology
  • Risk Factors
  • Rural Population
  • Tanzania / epidemiology

Substances

  • Anti-HIV Agents
  • Anti-Retroviral Agents
  • HIV Protease Inhibitors

Grants and funding

This work was supported by the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDEC) through the National Aids Control Programme, Tanzania; the Fonds für Entwicklungszusammenarbeit of the Canton Basel-Stadt, Switzerland; the Swiss Tropical and Public Health Institute, Switzerland; the University Hospital Basel, the Ifakara Health Institute, Tanzania and the United States Agency for International Development through the Boresha Afya Initiative. HM receives his salary through the Swiss Government Excellence Scholarships for Foreign Scholars (ESKAS-Nr: 2018.0004).