Renal insufficiency in Ghanaian HIV infected patients: need for dose adjustment.

BACKGROUND Antiretrovirals (ARVs) could lead to clinically significant nephrotoxicity and as such will require dose adjustments in the presence of renal insufficiency. OBJECTIVE To explore renal function estimating equations as alternatives for glomerular filtration rate (GFR) measurement in a stable cohort of HIV-infected patients. METHOD In estimating renal insufficiency in Ghanaian HIV-infected patients, GFR for 276 HAART-naïve patients and 166 patients on HAART was estimated with the Cockcroft-Gault, 4v-MDRD and CKD-EPI estimating equations. RESULTS Females outnumbered males by 3 to 1 in the HAART-naïve group and 4 to 1 in subjects on HAART. The prevalence of renal insufficiency calculated with the Cockcroft-Gault, 4v-MDRD and CKD-EPI equations was 8.7%, 9.1% and 8.7% in HAART-naïve patients; 14.5%, 12.6% and 12.6% in patients on HAART; 7.7%, 11.5% and 11.5% in HAART-naïve males; 10.8%, 8.1% and 8.1% in males on HAART; 9.1%, 8.0% and 7.5% in HAART-naïve females and 15.5%, 14.0% and 14.0% in females on HAART. The CKD-EPI equation yielded lower bias when compared to the Cockcroft-Gault and 4v-MDRD equations. CONCLUSION Renal insufficiency is not uncommon among HIV infected Ghanaian patients. A significant proportion (10 to 11%) will require ARV dose adjustment at the time of initiating therapy or sometime during on-going therapy.