An Assessment of Creatinine Clearance in HIV-Positive Patients on Tenofovir-Based Antiretroviral Regimens at Victoria Chitepo Provincial Hospital in 2025

Abstract

The assessment of renal function in HIV-positive patients on antiretroviral therapy (ART) remains a vital aspect of long-term disease management, particularly with the widespread use of tenofovir disoproxil fumarate (TDF), a first-line antiretroviral drug associated with potential nephrotoxicity. This study evaluated creatinine clearance and related renal parameters among HIV-positive patients initiated on tenofovir-based ART regimens at Victoria Chitepo Provincial Hospital in 2025. The objectives were to determine changes in renal function over a six-month period, identify sociodemographic factors associated with impaired renal clearance, and establish the prevalence of renal dysfunction in this population. A quantitative, cross-sectional research design was employed, involving 180 participants selected from an initial cohort of 220 patients through random sampling. Data were collected from clinical records, and serum creatinine levels were analyzed to estimate creatinine clearance (CrCl) and glomerular filtration rate (eGFR) using the Cockcroft–Gault equation, respectively. Statistical analysis was conducted using Microsoft Excel, applying chi-square tests and descriptive statistics to evaluate associations and trends. Findings revealed that both age and gender were significantly associated with poor renal creatinine clearance (p < 0.05). The highest incidence of renal dysfunction was observed among patients aged 65 years and above, reflecting age-related physiological decline in renal function compounded by drug-induced nephrotoxicity. Females demonstrated a higher prevalence of impaired renal clearance (72.7%) compared to males (42.9%), suggesting possible influences of hormonal and physiological differences, as well as socioeconomic disparities affecting health access and monitoring. The mean eGFR across all participants was 73.5 mL/min/1.73m², with 33.3% of patients exhibiting reduced renal function (eGFR < 60 mL/min/1.73m²). This prevalence indicates that approximately one in three patients developed some degree of renal impairment within six months of initiating tenofovir-based ART. Although most participants maintained adequate renal function, the presence of early renal dysfunction in a significant proportion underscores the need for frequent and proactive monitoring of kidney health during ART administration. The results align with findings from previous African and global studies that report tenofovir-associated nephrotoxicity within the first year of treatment. Age-related vulnerability, female predominance in renal dysfunction, and limited laboratory follow-up in resource-constrained settings were notable trends consistent with existing literature. The implications for public health are substantial: routine renal function screening should be integrated into HIV management programs to ensure early detection and mitigation of nephrotoxicity. This is particularly critical in Zimbabwe, where economic constraints often limit access to laboratory testing and patient follow-up. Strengthening laboratory infrastructure, ensuring the availability of renal test reagents, and building clinical capacity for kidney monitoring will enhance patient safety and treatment sustainability. In conclusion, this study demonstrates that tenofovir-based ART, though effective in suppressing HIV replication, presents a measurable risk of renal impairment, especially among elderly and female patients. The findings advocate for personalized ART management that considers patient demographics, comorbidities, and baseline renal function. The study contributes valuable data to the growing body of evidence on tenofovir-induced nephrotoxicity and reinforces the need for evidence-based monitoring protocols in HIV care. Continued research and policy attention toward renal safety in ART programs are essential to safeguard patient well-being and sustain the gains made in HIV treatment in sub-Saharan Africa.