SP269ANTIRETROVIRAL THERAPY-RELATED NEPHROTOXICITY IN HIV INFECTED PATIENTS WITH LOW BODY MASS INDEX OUTPATIENT FOLLOW-UP IN BRAZZAVILLE, CONGO

Abstract

Introduction and Aims: Aim of this study is to determine incidence, outcome and risk factors of antiretroviral therapy (ART)‐related nephrotoxicity in HIV infected patients with low Body Mass Index (BMI) outpatient follow‐up in Brazzaville, Congo Methods: All patients with low BMI enrolled at the Ambulatory treatment center in Brazzaville, Congo from 2009 to 2010 who were initiated on ART and had regular follow up serum creatinine values available were included in this retrospective study. We assessed renal function with the Cockcroft‐Gault equation standardized for body surface area. Factors associated with ART‐related nephrotoxicity (creatinine clearance (CC) decrease by 25% compared to baseline or a 0.5mg/dL increase in Serum creatinine (Scr) above baseline maintained on two consecutive measurements) were analyzed using Cox regression. Results: Overall, 126 patients, 71.4% female, were included. At the time of starting ART, median values was: age: 38 years [IQR=33‐45.35], weight: 45kg [IQR=42‐49], CD4 count: 126 cells/μl [IQR=29‐228], Scr: 0.9mg/dl [IQR=0.75‐1.13], and CC: 73ml/ min/m2 [IQR=59‐88]. Seventy‐six, 30, 17 and 3 patients had started ART respectively with protocol AZT+3TC( EFV=46/76 and NVP=30/76), TDF+FTC(EFV=27/30 and LPV/r=3/30), D4T+3TC(EFV=12/17 and NVP=5/17) and ABC+3TC+EFV. Median duration of follow up on ART was 23 months [IQR=10‐24], during this period ART‐related nephrotoxicity developed in 13 patients (incidence 10.3%), 7% died, 16% were lost to follow‐up and 4% were transferred‐out. The estimated probability nephrotoxicity was 3.03%,5.4%, 7.31%, 9.1%, 1.7% and 2.5% at 1,3,6,12,18 and 24 months respectively. Median time to developing ART‐related nephrotoxicity was 10 months [IQR=5‐13]. Among patients who started ART based on TDF, 8% had developed nephrotoxicity. Patients with normal renal function (CC≥90ml/min/m2) were at greatest risk of nephrotoxicity (aHR 3.18; 95%CI: 1.01‐10.04). Conclusions: The incidence of ART‐related nephrotoxicity is high in our cohort of patients with low BMI. Patients with normal renal function are at higher risk.