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 HAARTnaïve 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