Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Congella, Durban, 4013, South Africa.
Department of General Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Syst Rev. 2017 Oct 13;6(1):200. doi: 10.1186/s13643-017-0605-5.
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.
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.
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.
The findings of the review have implications to the recently adopted 'test and treat' approach to HIV prevention and management.
PROSPERO CRD42016039270.
据估计，南非将有 65 万艾滋病毒（HIV）相关肾病患者。南非最近采用了世界卫生组织的政策，规定所有 HIV 感染者不论 CD4 细胞计数如何，都可获得抗逆转录病毒治疗（ART）。
我们从 2015 年 7 月至 12 月，在 Google Scholar、PubMed、Medline、Cochrane 图书馆、Worldcat.org 和 EBSCOhost 数据库中进行了检索。纳入标准包括 2004 年至 2015 年期间在南非成年（≥18 岁）HIV 感染者中有关 HIV 肾脏表现的文章。我们独立地对文章进行了质量评估。采用主题内容分析法，从纳入的研究中确定肾脏表现的模式。采用混合方法评价工具评估纳入研究的偏倚风险（如内部有效性）。
21 篇研究中有 11 篇符合数据提取标准。尿试纸尿异常的发生率较高，但对检测肾功能不全的敏感性和特异性均较差。肾功能正常的患者占 28.4%至 79%，轻度肾功能不全的患者占 19%至 57.1%，中度肾功能不全的患者占 2%至 14.4%。肾功能严重不全的患者占 1.3%。经过校正偏倚后， Cockcroft-Gault 方程和 4 变量改良肾脏病饮食研究方程（不包括非洲裔美国人的种族因素）都已经在南非黑人中得到验证，可用于估计肾小球滤过率（eGFR）。最常见的组织学表现是 HIV 相关性肾病（57.2%）。年龄较大、CD4 计数较低、血红蛋白较低和可检测到的病毒载量与肾功能不全相关。开始接受 ART 治疗的第一年，肾功能就会改善，表现为蛋白尿的消退和 eGFR 的增加。
该综述的结果对最近采用的 HIV 预防和管理的“检测和治疗”方法具有启示意义。
PROSPERO CRD42016039270。
