Meeting cautions on rolling out ARVs

By HENRY NEONDO, Rio de Janeiro

At least one in four Kenyans living with HIV and AIDS and on ARV treatment suffer renal (kidney) disease
This contrasts the scenario found in Uganda where 1 in 2 PLWA and on ARV suffer the renal disease associated with misuse of ARVs.

These were the results of poster presentation presented at the recently concluded Third International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro, Brazil held from July24-27.

The level of renal insufficiency identified suggests the need for extensive education on antiretroviral dosage adjustments necessary for patients with renal insufficiency, and the need for assessment of creatinine clearance whenever symptoms suggestive of kidney disease are present in people receiving antiretroviral treatment in Africa.

The findings also suggest that tenofovir which sells as Viread locally- which may worsen kidney function in people with pre-existing impairment - may be not appropriate for a large number of Africans at the standard dosage.

A third poster presentation from the United Kingdom, however, suggested that highly active antiretroviral therapy (HAART) significantly improves HIV-associated nephropathy (kidney disease) outcomes.

HIV-associated nephropathy (HIVAN) is the leading cause of end-stage renal disease among HIV-positive individuals in well-resourced countries, most of whom are of African descent.

However, although HIVAN is clearly linked to African ethnicity, until now information has been severely lacking about renal disease in HIV-infected populations in Africa.

For the Kenyan case, researchers in western Kenya enrolled 219 antiretroviral-naïve individuals attending the HIV clinic in Eldoret, Kenya.

Patients with a previous diagnosis of renal disease, and those with diabetes mellitus, pregnancy, sickle cell disease, or acute infection were excluded.

Renal insufficiency was detected in 25%, with more severe renal insufficiency identified in 2%. Severe proteinuria was detected in 8%.

The investigators concluded that renal insufficiency and proteinuria are prevalent in this HIV-infected clinic population, which suggests that HIV-associated nephropathy may be common.

They suggest that to avoid drug toxicity, renal function should be assessed prior to commencing HAART.

While investigators from the HIV/AIDS clinic at Mbarara University Teaching Hospital, Uganda, enrolled all consenting adults who were seen for the first time at the clinic between June and August 2003.

However, these results confirm that kidney dysfunction is highly prevalent among Africans in Africa.

These data should inform decisions regarding the rollout of tenofovir-containing HAART in sub-Saharan Africa, since studies have shown that underlying kidney dysfunction greatly increases the risk of tenofovir-related kidney toxicity.


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