1. ¹Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
2. ²Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
3. ³CDC-Uganda, Global AIDS Program, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, and Uganda Virus Research Institute, Entebbe, Uganda
4. ⁴British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
5. ⁵Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Correspondence: Philip J. Peters, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45, Atlanta, Georgia 30333. E-mail: pjpeters@cdc.gov

Received 12 January 2008; Revised 17 April 2008; Accepted 29 April 2008; Published online 9 July 2008.

Abstract

Renal dysfunction is a severe complication of advanced HIV disease. We evaluated the impact of highly active antiretroviral therapy (HAART) on renal function among HIV-infected Ugandans in the Home-Based AIDS Care clinical trial. The patients presented with symptomatic HIV disease or CD4 cell count 250 cells/mm³ and creatinine clearances above 25 ml/min determined by the Cockcroft-Gault equation. Of the 508 patients at baseline, 8% had a serum creatinine over 133 mol/l and about 20% had reduced renal function evidenced by a creatinine clearance between 25 and 50 ml/min. After 2 years of HAART, the median serum creatinine was significantly decreased by 16% while the median creatinine clearance significantly increased 21%. The median creatinine clearance of patients with renal dysfunction at baseline, increased by 53% during 2 years of treatment. In multivariable analysis, a baseline creatinine above 133 mol/l, a weight gain of more than 5 kg over the 2 years, female gender and a WHO stage 4 classification were all associated with greater improvements in creatinine clearance on HAART. Our study shows that renal dysfunction was common with advanced HIV disease in Uganda but this improved following 2 years of HAART.