ASSESSMENT OF RENAL FUNCTION IN HIV/AIDS PATIENTS ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)

(A CASE STUDY OF ABUTH, ZARIA)

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Author

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Department of Medicine

ABSTRACT
Acquired immunodeficiency syndrome (AIDS) is a spectrum of disease states characterised by progressive immunosuppression. It results from infection with Human Immunodeficiency Virus (HIV) which is capable of affecting every organ system in the body. Renal complications are important component of advanced HIV disease, and these complications significantly contribute to morbidity and mortality in these patients. Therefore regular assessment of their renal status using sensitive markers such as Creatinine Clearance (CrCl) together with serum electrolytes, creatinine, urea and uric acid is necessary. The objective of this study was therefore to assess the renal function, determine the appropriate assessment parameters and the prevalence of renal disease among HIV/AIDS patients on highly active antiretroviral therapy (HAART) in ABUTH, Zaria. Renal function of 101 HIV positive patients on HAART and 100 controls was assessed. The data obtained were analysed using statistical programme for the social sciences 11.0 (SPSS 11.0).Two-tailed student?s t-test r matched samples and Pearson’s linear correlation statistical methods were employed for the analysis. A p-value of equal to or less than 0.05 (p≤ 0.05) was considered as statistically significant. Mean levels of Na+, K+, HCO3-, Cl-, Ca2+ and PO42- obtained in patients were 138.97±0.43, 3.83±0.05, 25.28±0.26, 100.02±0.42, 2.62±0.03 and 1.21±0.03 mmol/L respectively, whereas the corresponding values in controls were 138.84±0.26, 3.96±0.04, 25.78±0.16, 98.90±0.35, 2.31±0.02 and 1.22±0.02 mmol/L respectively. These results showed that K+ was significantly lower (p< 0.05) while Cl- and Ca2+ were significantly higher (p< 0.05 and p< 0.001 respectively) in patients than in controls. Also the mean levels of estimated creatinine clearance (eCrCl), creatinine, uric acid and urea in patients were 121.52±4.95 ml/min, 65.29±2.61 µmol/L, 258.62±8.32 µmol/L and 4.27±0.20 mmol/L respectively, whereas the corresponding values in controls were 121.04±2.62, 74.46±1.33, 204.00±5.35 and 5.02±0.09 respectively. These results showed that creatinine and urea were significantly lower (p< 0.01) while uric acid was significantly higher (p< 0.001) in patients than in controls. This study demonstrated that all analytes in both patients and controls were within normal reference ranges for this environment. The study also showed that 26 (25.7%) patients had decreased eCrCl as against 12 (12.0%) controls. Nineteen (18.8%) of the patients with decreased eCrCl had eCrCl of < 90 ml/min (stage 2 CKD) with the remaining 7 (6.9%) having eCrCl of <60 ml/min (stage 3 CKD). Of all the patients with deranged renal function using eCrCl, only 4 would have been detected using serum creatinine with or without proteinuria. It was also found that 48(47.5%) of the patients were overweight to mild obesity as against 26 (26.0%) controls. The findings in this study demonstrates a higher prevalence of renal disease in patients and that eCrCl is a better marker than serum electrolytes, urea, creatinine and uric acid in assessing renal function in these patients. It is therefore recommended that GFR should be assessed regularly using prediction formula (Cockcroft and Gault formula) in HIV/AIDS patients on HAART.