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Resume Contexte Evaluer l’incidence et les facteurs associes a la nephrotoxicite et la maladie renale chronique apres initiation du traitement antiretroviral chez les patients infectes par le VIH avec un faible indice de masse corporelle ( Methodes Les patients avec une baisse du debit de filtration glomerulaire de 25 % ou une augmentation de la creatinine serique de 0,5 mg/dL par rapport aux valeurs initiales ont ete retenus comme ayant une nephrotoxicite. La maladie renale chronique a ete definie comme une chute du debit de filtration glomerulaire Resultats Sur 325 patients selectionnes, 73,23 % etaient des femmes. Les valeurs medianes etaient un âge de 37,55 ans (IQR = 33,51–44,96), un poids de 45 kg (IQR = 41–49), des CD4 a 137,5 cellules/mm3 (IQR = 42–245). L’incidence de la nephrotoxicite et de la maladie renale chronique etait de 27,95 et 7,44 pour 100 personnes-annee respectivement. En analyse multivariee, le taux d’hemoglobine ≤ 8 g/dL (aHR = 2,25 ; IC 95 % 1,28–3,98 ; p = 0,005) et l’utilisation du tenofovir (aHR = 1,51 ; IC 95 % 1,01–2,27 ; p = 0,04) etaient les facteurs de risque associes a la nephrotoxicite. Le debit de filtration glomerulaire compris entre 60 et 80 (aHR = 0,35 ; IC 95 % 0,21–0,59 ; p Conclusion L’incidence de la nephrotoxicite et de la maladie renale chronique etait elevee. Les patients VIH-positifs avec indice de masse corporelle

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/mA 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/1.73mOf 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; P0.001) and 45-59mL/min/1.73 mIncidence 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.

To document the actual genetic diversity of HIV-1 strains in the Republic of Congo, 114 HIV-1 positives persons were sampled in 2003 and 2004 after their informed consent. They were attending the teaching hospital, the reference health center in Makelekele, Brazzaville and the regional hospital centers in Pointe-Noire, Gamboma and Ouesso. A total of 104 samples were genetically characterized by direct sequencing of the p24 gag region and 80 were also subtyped in the V3-V5 env region. The genetic subtype distribution of the Congolese strains showed the predominance of subtype A (36.5% and 32.5% in gag and env, respectively) and G (30.8% and 21.25%), whereas subtype D strains represented 12.5% and 15%. Subtypes C, F, H, J, K and the CRFs-01, -02, -05 -06, and also the recently characterized CRF18 were seen at lower rates. Finally, 4.8% (gag) and 6.25% (env) of the strains could not be classified. Moreover, a high intra-subtype diversity was observed in our study. Among 70 strains which have been characterized in the two genomic regions, 14 (20%) appeared to be unique recombinants. These data show a high genetic variability in the Republic of Congo, where all the subtypes have been documented together with certain subsubtypes and several CRFs. (c) 2006 B.V. All rights reserved.