Use of pre-ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire.

Autor: Minchella PA; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Adjé-Touré C; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire., Zhang G; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Tehe A; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire., Hedje J; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire., Rottinghaus ER; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Natacha K; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire., Diallo K; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa., Ouedraogo GL; Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire., Nkengasong JN; Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2020 Apr; Vol. 25 (4), pp. 408-413. Date of Electronic Publication: 2020 Jan 20.
DOI: 10.1111/tmi.13364
Abstrakt: Background: High demand for HIV-services and extensive clinical guidelines force health systems in low-resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre-antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification.
Methods: We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART-naïve patients with specimens referred to the RETRO-CI laboratory in Abidjan, Côte d'Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT) and haemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate < 50 mL/min), hepatic abnormalities (ALT > 5× upper limit of normal) and severe anaemia (Hb < 6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question.
Results: The prevalence of renal dysfunction, hepatic abnormalities and severe anaemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anaemia were age > 50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19-2.92; P < 0.001) and CD4 < 100 cells/µl (aOR: 2.57; 95% CI: 2.30-2.88; P < 0.001).
Conclusion: The relative infrequency of conditions linked to toxicity in Côte d'Ivoire supports the notion that simplification of pre-ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.
(Published 2019. This article is a U.S. Government work and is in the public domain in the USA.)
Databáze: MEDLINE
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