Background:  Although renal dysfunction is a common complication of advanced HIV disease, little is known about its prevalence in Africa. Moderate renal dysfunction can complicate antiretroviral treatment by requiring dose adjustments for some medications.

Methods:  From May 2003 to December 2004, the Home-based AIDS Care (HBAC) program initiated HAART for 1029 ART-naive patients with symptomatic HIV disease or CD4 cell count ≤250 cells/mm³ and estimated creatinine clearance >25 mL/minute. Standard weight-based dosing was administered but not adjusted for renal function. HBAC provides weekly drug delivery, adherence monitoring, and targeted clinic visits. We analyzed serum specimens for creatinine from a subset of 507 patients whose specimens were available from baseline and month 24. Creatinine clearance was estimated by the Cockcroft-Gault equation. The Wilcoxon rank sum and chi-square tests were used to evaluate changes in creatinine levels and to compare rates of moderate renal dysfunction (creatinine ≥1.50 mg/dL).

Results:  Patients (59% women, median age 39 years, median CD4 cell count 122 cells/mm³, median viral load 245,000 copies/mL, and median weight 54 kg) received stavudine + lamivudine with nevirapine (495 patients, 98%) or efavirenz (12 patients, 2%). Baseline median creatinine was 1.10 mg/dL and 54 (11%) of 507 patients had a creatinine ≥1.50 mg/dL. Median creatinine clearance was 62.5 mL/min and 107 (21%) of 504 patients had creatinine clearance  <50 mL/minute. Characteristics associated with moderate renal dysfunction at baseline were age of ≥45 years (p = 0.01) and male gender (p = 0.0001), but not CD4 cell count or viral load. Median creatinine decreased at 12 months to 0.99 mg/dL and at 24 months to 0.92 mg/dL (16% decline from baseline, p <0.0001). At 24 months only 13 (3%) of 507 patients had a creatinine ≥1.50 mg/dL (p <0.0002 vs baseline). After 24 months of follow-up the median creatinine clearance increased to 76.3 mL/minute (22% increase from baseline, p <0.0001) and only 32 (6%) of 504 patients had a creatinine clearance ≤50 mL/minute (p <0.0001 vs baseline). Among patients (n = 54) with moderate renal dysfunction at baseline, creatinine decreased from a median of 1.60 mg/dL to 1.05 mg/dL at 24 months (39% decrease, p <0.0001).

Conclusions:  Moderate renal dysfunction was common among this population with advanced HIV disease in rural Uganda, but improved during 2 years of non-nucleoside reverse transcriptase inhibitor-based HAART. Improvements in renal function are most dramatic in patients with moderate renal dysfunction at baseline.