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Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review

BACKGROUND: It is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa. South Africa has recently adopted WHO policy, stipulating that all HIV-infected patients have access to antiretroviral treatment (ART) irrespective of CD4 cell coun...

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Autores principales: Assaram, Shirelle, Magula, Nombulelo P., Mewa Kinoo, Suman, Mashamba-Thompson, Tivani P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640942/
https://www.ncbi.nlm.nih.gov/pubmed/29029647
http://dx.doi.org/10.1186/s13643-017-0605-5
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author Assaram, Shirelle
Magula, Nombulelo P.
Mewa Kinoo, Suman
Mashamba-Thompson, Tivani P.
author_facet Assaram, Shirelle
Magula, Nombulelo P.
Mewa Kinoo, Suman
Mashamba-Thompson, Tivani P.
author_sort Assaram, Shirelle
collection PubMed
description BACKGROUND: It is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa. South Africa has recently adopted WHO policy, stipulating that all HIV-infected patients have access to antiretroviral treatment (ART) irrespective of CD4 cell count. METHODS: We searched Google Scholar, PubMed, Medline, Cochrane Library, Worldcat.org and EBSCO host databases from July 2015 to December 2015. Eligibility criteria included articles pertaining to renal manifestations of HIV in South Africa from 2004 to 2015 in adult patients (≥ 18 years). We independently reviewed the articles for quality. Thematic content analysis was performed to identify patterns of renal manifestations from the included studies. The risk of bias (e.g. internal validity) in the included studies was evaluated using the mixed methods appraisal tool. RESULTS: Eleven out 21 studies were eligible for data extraction. The prevalence of urine abnormalities on urine dipsticks was high but had poor sensitivity and specificity for detecting renal impairment. Normal renal function occurred in 28.4 to 79% of patients, mild renal impairment occurred in 19 to 57.1% and moderate renal impairment in 2 to 14.4%. Severe renal impairment occurred in 1.3% of patients. Both the Cockcroft-Gault equation (after correcting for bias) and the 4-variable Modification of Diet in Renal Disease equation (without the ethnicity factor for African Americans) have been validated for the estimation of glomerular filtration rate (eGFR) in Black South Africans. HIV-associated nephropathy was the most prevalent histology seen (57.2%). Older age, a lower CD4 count, a low haemoglobin and a detectable viral load were associated with renal impairment. Renal function improved in the first year of commencing ART as evidenced by the regression of proteinuria and the increase in eGFR. CONCLUSION: The findings of the review have implications to the recently adopted ‘test and treat’ approach to HIV prevention and management. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039270 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13643-017-0605-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-56409422017-10-18 Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review Assaram, Shirelle Magula, Nombulelo P. Mewa Kinoo, Suman Mashamba-Thompson, Tivani P. Syst Rev Research BACKGROUND: It is estimated that 650,000 patients may develop human immunodeficiency virus (HIV)-related renal disease in South Africa. South Africa has recently adopted WHO policy, stipulating that all HIV-infected patients have access to antiretroviral treatment (ART) irrespective of CD4 cell count. METHODS: We searched Google Scholar, PubMed, Medline, Cochrane Library, Worldcat.org and EBSCO host databases from July 2015 to December 2015. Eligibility criteria included articles pertaining to renal manifestations of HIV in South Africa from 2004 to 2015 in adult patients (≥ 18 years). We independently reviewed the articles for quality. Thematic content analysis was performed to identify patterns of renal manifestations from the included studies. The risk of bias (e.g. internal validity) in the included studies was evaluated using the mixed methods appraisal tool. RESULTS: Eleven out 21 studies were eligible for data extraction. The prevalence of urine abnormalities on urine dipsticks was high but had poor sensitivity and specificity for detecting renal impairment. Normal renal function occurred in 28.4 to 79% of patients, mild renal impairment occurred in 19 to 57.1% and moderate renal impairment in 2 to 14.4%. Severe renal impairment occurred in 1.3% of patients. Both the Cockcroft-Gault equation (after correcting for bias) and the 4-variable Modification of Diet in Renal Disease equation (without the ethnicity factor for African Americans) have been validated for the estimation of glomerular filtration rate (eGFR) in Black South Africans. HIV-associated nephropathy was the most prevalent histology seen (57.2%). Older age, a lower CD4 count, a low haemoglobin and a detectable viral load were associated with renal impairment. Renal function improved in the first year of commencing ART as evidenced by the regression of proteinuria and the increase in eGFR. CONCLUSION: The findings of the review have implications to the recently adopted ‘test and treat’ approach to HIV prevention and management. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039270 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13643-017-0605-5) contains supplementary material, which is available to authorized users. BioMed Central 2017-10-13 /pmc/articles/PMC5640942/ /pubmed/29029647 http://dx.doi.org/10.1186/s13643-017-0605-5 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Assaram, Shirelle
Magula, Nombulelo P.
Mewa Kinoo, Suman
Mashamba-Thompson, Tivani P.
Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review
title Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review
title_full Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review
title_fullStr Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review
title_full_unstemmed Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review
title_short Renal manifestations of HIV during the antiretroviral era in South Africa: a systematic scoping review
title_sort renal manifestations of hiv during the antiretroviral era in south africa: a systematic scoping review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640942/
https://www.ncbi.nlm.nih.gov/pubmed/29029647
http://dx.doi.org/10.1186/s13643-017-0605-5
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