Chronic Renal Disease Clinical Trial
Official title:
Baseline Characteristics and Long Term Clinical Outcomes of Patients Using Malawi's New First Line Antiretroviral Regimen at Lighthouse: The Lighthouse Tenofovir Cohort
Lighthouse, in cooperation with the University Heidelberg Public Health Institute and the
University Köln (Cologne) would like to set up a cohort to study baseline characteristics and
long-term clinical outcomes of patients using Tenofovir based Antiretroviral Therapy at the
Lighthouse. As of March 2014, patients above 18 years and giving informed consent coming to
the Lighthouse to newly initiate ART will be approached to enroll in the cohort.
The results will be disseminated both nationally at the Ministry of Health Technical Working
Group (TWG), at the annual Research Dissemination and Best Practices conferences of the
College of Medicine and National AIDS Commission as well as internationally. The results will
also be written up for publication in appropriate peer-reviewed journals.
The proposed observational cohort study will lead to improved identification of patients with
virological failure and adverse drug effects, improved identification of relevant
co-morbidities and result in better individual management. More importantly however, the
results will allow estimates for the proportion of the described complications in the overall
Malawian treatment cohort. This claim can be exemplified by the retrospective analysis of
patients at the Lighthouse who were switched from the new 5A regimen to 6 A regimen as a
result of adverse effects of Efavirenz.
The aim of this study is to describe baseline clinical characteristics and long-term outcomes
of patients using Tenofovir based antiretroviral therapy at the Lighthouse Clinics. The
specific objectives are outlined below:
Objective 1: To determine the prevalence of renal dysfunction at enrolment and during
follow-up among adult HIV-infected individuals starting ART.
Objective 2: To determine the prevalence of Hepatitis B Virus (HBV) and Hepatitis C Virus
(HCV) infections among adult HIV-infected individuals starting ART and during treatment
follow-up.
Objective 3: To determine the prevalence of non-communicable co-morbidities during treatment
follow-up of HIV-infected individuals starting ARTand during treatment follow-up.
The study will take place at the Lighthouse, a tertiary referral ART centre, with over 25,000
patients, in Lilongwe, Malawi. Considering the study cost and power to detect a prevalence of
22% for renal impairment, we expect to have a convenience sample size of at least 850
patients at the end of three year follow-up period. The current retention at three years is
almost 56%. Using this retention, we will therefore enrol almost 1,500 patients starting ART.
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