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Renal Insufficiency among HIV-infected, ART-naïve Individuals in Lilongwe, Malawi: Implications for Tenofovir use in antiretroviral treatment and prevention of mother to child transmission programs.
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Reported by Jules Levin
CROI 2011 March 2 Boston
D. Johnson1, C. Chasela1, M. Maliwichi1, A. Mwafongo1, A. Akinkuotu1, A. Moses1, D. Jamieson2, A. Kourtis2, C. van der Horst1, M. C. Hosseinipour1.
1 University of North Carolina Project Malawi, 2 Center of Disease Control, Breastfeeding Antiretroviral And Nutrition Study (BAN).
Contact: Derek Johnson, frg1@uab.edu
RESULTS
The majority of study subjects were female (90.6 %) with a median age of 26 years (IQR 22-29). The median CD4 cell count was 444 cells/mm3 (IQR 298.0 - 561.0). The majority of our study population was pregnant (84.6%) due to the large proportion of participants included in this study from the BAN clinical trial.
Most patients (3482, 98.9%) had CrCl ≥ 50ml/min. Among patients eligible for ART (CD4 <350, n =1323), approximately 98.1% had CrCl ≥ 50ml/min. Mean BMI for individuals with CrCl ≥ 50ml/min was significantly higher compared to individuals with CrCl < 50ml/min (Mean (SD): 23.5 (3.2) vs. 19.4 (2.3), p-value <0.001). Compared to those with CrCl >50 ml/min, individuals with CrCl < 50ml/min were significantly more likely to have CD4+ T-cell counts less than 350 (62.7% vs. 35.9%, p-value <0.001) and less likely to be pregnant (51.3% vs. 82.4%, p-value <0.001)
Adjusted multivariate logistic regression models found increases in BMI were associated with decreased odds of having CrCl < 50ml/min (OR 0.64 95%CI 0.52, 0.79, p-value <0.001). A one unit increase of hemoglobin (1 g/dL ) was found to reduce the odds of CrCl < 50ml/min by 19% (OR 0.81 95%CI 0.66, 0.99, p-value 0.04). Individuals who were not pregnant were more likely than individuals who were pregnant to have a CrCl < 50ml/min (OR 5.80 95%CI 1.84, 18.29, p-value 0.003).
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