Screening and management of renal disease in human immunodeficiency virus-infected patients in Australia

Renal disease has become one of the most important co-morbidities observed in the human immunodeficiency virus (HIV) infected patient cohort. Data is lacking on the current screening and management of renal disease in patients with HIV. We evaluated HIV-infected Australian adults in primary care to determine current practices. METHODS: : This prospective, multicentre observational study included two rounds of data collection; the first was followed by an educational program. Outcomes included screening for renal disease; management of risk factors for kidney disease and other co-morbidities associated with renal disease. RESULTS: : 53 general practitioners (GPs) participated with 733 patients enrolled. Most were male (94 ), almost 40 were 41 to 50 years-of-age, 6 and 84 were receiving antiretroviral therapy. Co-morbidities were common; 19 had hypertension, 5 were diabetic, 32 were dyslipidaemic and 40 were smokers. Estimated glomerular filtration rate (eGFR) was commonly measured in both rounds of data collection (96 vs. 95 ). Proteinuria was assessed less frequently; this improved after education (48 vs. 71 ). Almost 10 of patients tested had proteinuria on urinalysis. Of the 45 patients (6 ) with renal impairment (eGFR <60 ml/min), none were referred for assessment by a renal specialist. CONCLUSIONS: : This large observational study provides important information on renal disease in HIV-infected patients, an area with a paucity of clinical data. Current screening and management practices fall short of suggested guidelines. Failure to refer patients to specialists is a major deficiency. Improvements with education suggest the need to promote awareness of guidelines in primary care doctors.