Prevalence and utility of dipstick proteinuria in predicting renal insufficiency in treatment naive human immunodeficiency virus (HIV) infected Africans

This study investigated the prevalence and associated factors of proteinuria in treatment naive human immunodeficiency virus (HIV) infected individuals. It also evaluated utility of dipstick urinalysis for the detection of impaired renal function. Two hundred (200) HIV seropositive patients and 72 HIV seronegative subjects were evaluated and tested for proteinuria using dipstick reagent strips. Serum urea and creatinine, haemoglobin, CD4+ T-lymphocyte (CD4+ cell) count and HIV RNA viral load were performed. Cockroft-Gault (CG) equation was used to estimate glomerular filtration rate (eGFR). Dipstick proteinuria was detected in 85 (43%) of the seropositive population compared to 6 (8.3%) in HIV seronegative subjects (odds ratio (OR) 8.3, p < 0.001). One hundred (50%) HIV positive subjects had CD4+ cell < 200 cells at baseline and 63 (31%) had impaired renal function. Although dipstick proteinuria was associated with male gender, severe anaemia, elevated serum urea and creatinine, significantly lower CD4+ cell count and impaired renal function, only the inverse association of dipstick proteinuria and CD4+ cell count remained on logistic regression (OR 0.4, 95% CI: 1.6 to 5.2). We have documented the high prevalence of proteinuria in HIV subjects prior to anti retroviral therapy (ART), and the important role of proteinuria as a significant risk factor for severe immunosuppression. We also show that dipstick proteinuria is not sensitive for the identification of impaired renal function, but has moderate utility in excluding renal insufficiency in subjects negative for proteinuria on dipstick testing.