Peters PJ et al. (2008) Antiretroviral therapy improves renal function among HIV-infected Ugandans. Kidney Int 74: 925–929

Highly active antiretroviral therapy (HAART) seems to improve renal function in patients with HIV; however, some antiretroviral drugs require dose adjustment in the setting of renal dysfunction and others can even cause renal impairment. Peters et al. have evaluated the importance of monitoring renal function in a rural population of patients on HAART.

The cohort comprised 508 HIV-positive Ugandan adults with symptomatic disease or a CD4 cell count not exceeding 250 cells/mm3 (median age 39 years; 59% female) who had been monitored for at least 2 years after initiation of HAART with stavudine plus lamivudine and either nevirapine or efavirenz, and had undergone measurement of serum creatinine level at 1 year and 2 years. Individuals with a baseline Cockcroft–Gault-estimated creatinine clearance <25 ml/min were excluded.

At baseline, 8% of participants had an elevated serum creatinine level (≥133 µmol/l) and 20% had reduced renal function (creatinine clearance 25–50 ml/min). During the follow-up period, the median serum creatinine level declined by 16% and the median creatinine clearance increased by 21% (P <0.0001 for both). Among patients with reduced renal function, the improvement was more marked; median creatinine clearance increased by 53% (P <0.0001). De novo reduction of creatinine clearance (to ≤50 ml/min) occurred in 19 patients during the study.

The authors conclude that in settings where regular monitoring of renal function cannot always be performed, first-line HAART can initially be dosed simply on the basis of body weight.