[Low Body Mass Index and impact of antiretroviral therapy on nephrotoxicity, chronic renal disease among HIV-infected patients in Brazzaville, Congo]. / Faible indice de masse corporelle et impact des antirétroviraux sur la néphrotoxicité, la maladie rénale chronique chez les patients infectés par le VIH à Brazzaville, Congo.

OBJECTIVE: To describe the incidence and risks factors of ART induced nephrotoxicity and chronic kidney disease in HIV-1-infected adults with low body mass index (<18.5kg/m2). METHODS: A retrospective cohort study at the Ambulatory Treatment Center in Brazzaville, Congo. Patients with estimated glomerular filtration rate decrease by 25% compared to baseline or a 0.5mg/dL increase in serum creatinine above baseline were classified as having nephrotoxicity, and chronic kidney disease was defined as a value less than 60mL/min/1.73m2. We used Cox proportional hazards regression models to determine factors associated with nephrotoxicity and chronic kidney disease. RESULTS: Of 325 patients, 73.23% were women. Median values were an age 37.55 years (IQR: 33.51-44.96), weight 45kg (IQR: 41-49), CD4 count 137.5 cells/µL (42-245). In the first 24-months, follow-up on ART incidence rate of nephrotoxicity and chronic kidney disease was 27.95 and 7.44 per 100 persons-year respectively. Multivariate analysis identified as a risk factor of nephrotoxicity, baseline haemoglobin below or equal 8g/dL (aHR=2.25; 95%CI 1.28-3.98; P=0.005) and the use of tenofovir (aHR=1.51; 95%CI 1.01-2.27; P=0.04). DFG between 60-80 mL/min/1.73 m2 (aHR=0.35; 95%CI 0.21-0.59; P<0.001) and 45-59mL/min/1.73 m2 (aHR=0.10; 95%CI 0.01-0.72; P=0.02) was not a contraindication for initiating antiretroviral therapy. Each 10-year older age was associated with an increased risk of developing chronic kidney disease (aHR=1.95; 95%CI 1.2-3.17; P=0.007). CONCLUSION: Incidence of nephrotoxicity and chronic kidney disease were high. African HIV-positive patient with low body mass index at baseline need close monitoring of their renal function when treated with tenofovir.

Is gender a factor associated with initiation of antiretroviral therapy at the Ambulatory Treatment Centre of Brazzaville? / Le genre est-il un facteur associé à la mise sous traitement antirétroviral au Centre de Traitement Ambulatoire de Brazzaville ?

Objective: To assess the initiation of antiretroviral therapy with respectto gender at the Brazzaville Ambulatory Treatment Centre, Republic of Congo (CTA). Methods: A retrospective cohort study of HIV-positive patients enrolled at the CTA between january 2005 and december 2006 with 4 years of follow-up up until December 2010. The primary endpoint was the proportion of patients initiating antiretroviral therapy (ART) among those meeting the conditions for ART. We investigated the factors associated with initiation of ART using multiple Cox regression models. Kaplan-Meier curves were used to estimate the proportion of patients initiating ART. Results: A total of 1,012 patients with a median age of 38.15 years (IQR: 31.81 ­ 44.54) were included. Eight hundred fourteen patients (84.8%) had baseline CD4 count < 200 cells/mm3 and 604 patients (59.7%) were at WHO clinicalstage III and IV. 64.82 % of these patients were women. Five hundred and forty-two (53.56%) patients received ART and the median time to initiation of ART was 28.42 weeks. Men (aHR: 1.56; 95%CI = 1.13 ­ 2.16; p = 0.007) and patients with baseline haemoglobin above 10g/dL (aHR: 1.68; 95%CI: 1.25 ­ 2.27; p = 0.001) were more likely to initiate ART. Conclusion: Patients admitted to the Brazzaville Ambulatory Treatment Centre were predominantly women with irregular monthly income. Being a man and having a baseline haemoglobin greater than or equal to 10 g/dL were associated with more rapid initiation of antiretroviral therapy.