Evaluation of Renal Functions among HIV Infected Patients Using Antiretroviral Therapy

Abstract

The introduction of highly active antiretroviral therapy (HAART) has significantly improved the quality of life and extended the longevity of HIV-infected individuals on treatment in both developed and developing nations. However, the greatest disadvantage of long-term HAART usage is the risk of liver and kidney damage, which can be fatal. The medicines accumulate aggressively in the proximal renal tubule, causing functional disruption, with mitochondrial damage being one of the most critical targets identified. Therefore, the aim of this retrospective comparative study is one of the little studies conducted to evaluate the renal functions among PLHIV receiving antiretroviral combination compared to naive subjects, the present study consisted of 100 treated and 20 untreated subjects, their mean age was (29.41) ranging between (18-68), the gender distribution was equal (50% female, 50% males), teenage was the most predominant age group in the study. Creatinine levels were high in both treated and untreated HIV subjects, with no significant differences among them. In the treated subjects the prevalence of the high creatinine was 67%. Only 23% of the treated subjects reported elevated serum urea level, with no significant differences between the two study groups. The mean of eGFR in untreated subjects was 98.9ml/min and 77.3ml/min in treated HIV subjects. Most study subjects were had mildly reduced kidney function in both treated and untreated (55% and 50%) respectively. In un treated subjects 35% had normal kidney function and 15% had mildly to moderately reduced kidney function, In contrast to the treated subjects only 25% had normal kidney function, 14% demonstrated mildly to moderately reduced kidney function, 6% recorded moderately to severely reduced kidney function. None of the study subjects demonstrated advanced renal failure. The prevalence of renal impairment in the treated group, defined as eGFR <60ml/min/ 1.73m2 using the Cockcroft-Gault formula was 20% in treated subjects, while it was only 15% in the untreated subjects. Notably, the prevalence rate of renal impairment among untreated HIV subjects was also high at 15% though significantly different from the HAART-treated group. The association between high creatinine and HAART usage was highly significant, higher proportion of the study subjects on FTC+ TDF + LPV/r subjects on FTC+ TAF + EVG/c had high creatinine. Subjects with mildly reduced kidney function was associated with all HAART groups, Stage 3a (with mildly to moderately reduced kidney function) were associated with receiving FTC+ TDF + RAL and FTC + TDF + EFV combinations. Most study subjects (88%) were using antiretroviral therapy containing tenofovir disoproxil fumarate (TDF) which was demonstrated to have severe renal complications in most previous studies. No significant association between gender and prevalence of abnormal kidney function among both treated and untreated subjects, eGFR was more reduced in male gender than female in untreated subjects, in the treated subjects females had more advanced cases of renal impairments with no significant difference. No significant effect of age on renal functions (creatinine and urea) in both treated and untreated subjects, eGRF was significantly reduced in HIV treated subjects, characteristically, the prevalence of renal impairment was higher in patients aged above 40 years in HAART treated groups, there was 6 patients at stage 3b and 5 patients at stage 4