RENAL DYSFUNCTION IN HIV/AIDS PATIENTS ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY AT THE YAOUNDE JAMOT’S HOSPITAL

Harvey ONANA ATANGA (onanaharvey@gmail.com)
Internal Medicine and Specialities, The University of Yaounde 1
June, 2014
 

Abstract

ABSTRACT

Background and Rationale: HIV/AIDS is a pandemic affecting about 34 million persons with most of them living in Sub-Saharan Africa. Though the introduction of highly active antiretroviral therapy (HAART) has drastically reduced the incidence of opportunistic infections and overall patient mortality, the frequency of some non-communicable disorders shows an increasing trend in this population. De novo renal disease has been reported in 7.1-81%% of patients on HAART, with various factors associated with it such as: tenofovir use, long duration of infection, older age, low body weight, poor immunological status, female sex, hypertension and diabetes are some of the risk factors for renal disease in this population. The national guidelines however recommend renal function screening only for patients on tenofovir regimens. A few studies done in Yaounde showed a low prevalence of renal dysfunction in patients on HAART; but these studies did not evaluate tubular dysfunction, thus underestimating the prevalence of renal dysfunction in this population. We therefore sought to evaluate the different aspects renal function inpatients on HAART as a contribution to the clinical management of patients living with HIV/AIDS.

Objective: The main aim our study was to evaluate the renal function of HIV/AIDS patients on highly active antiretroviral therapy.
Materials and methods: From December 2013 to April 2014 we carried out a cross sectional study at the HIV/AIDS management unit of the Yaoundé Jamot’s Hospital. Patients above 21years old and receiving HAART since at least 2 months were included. Relevant clinical data was collected from the patients and their medical records. Random urine and blood samples were then collected from all consenting participants for analysis at the IMPM Laboratory. Renal function parameters evaluated were: serum and urine creatinine and uric acid, urinary protein excretion, glycosuria, fractional excretion of uric acid and estimated glomerular rate (eGFR). Proteinuria and glycosuria were evaluated by urinary dipsticks. The eGFR was calculated using the CKD-EPI equation. Our data was analysed using Epi info 7.1.3 and SPSS 22. We performed univariable and multivariable analyses, to determine predictors of renal dysfunction. The level of statistical significance was set at a p value < 0.05.

Results: A total of 98 participants were included of whom 72 (74.5%) were females. The median age of participants was 38.0(IQR 32.8-46.0) years. The medians for the known duration on HAART and Lowest CD4 count were 32.5 months and 136 respectively. Forty-five patients used nephrotoxic drugs concomitantly and 56 participants were receiving tenofovir containing regimens. The prevalence of renal dysfunction, a decreased eGFR, tubular dysfunction and proteinuria were at 66.3%, 38.8%, 16.3% and 4.1% respectively. There was no difference in the prevalence of renal dysfunction between tenofovir and non tenofovir participants. Older age, female sex and longer duration of infection (p < 0.01) were the only factors associated with decreased eGFR. No factor was associated with tubular dysfunction.

Conclusion: The prevalence of renal dysfunction is high in patients receiving HAART. Tenofovir is not associated with higher frequency of tubular dysfunction or decreased eGFR. Older age, female sex and longer duration of infection are associated with a decreased eGFR. Given these results it might be necessary to include monitoring of renal function in patients not on tenofovir.


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