Characteristics and Associations of Renal Dysfunction at Presentation in Haart-Naïve HIV-Infected Subjects in Port Harcourt, Nigeria

Title: Characteristics and Associations of Renal Dysfunction at Presentation in Haart-Naïve HIV-Infected Subjects in Port Harcourt, Nigeria

Authors: OKO-JAJA, Richard I., AWOPEJU, Abimbola Temitayo O

DOI: http://dx.doi.org/10.18535/jmscr/v4i7.11

Abstract

References

Corresponding Author

Abstract

Renal impairment is a major concern for HIV-infected individuals. It affects the way of life of the patients and could lead to a poor prognosis during the course of treatment. A retrospective study of 375 newly-diagnosed HAART naïve HIV-infected individuals from April 2014 to April 2015 was carried out. Information collected from the patients’ hospital folders include: Data and reports of biochemical and hematological investigations. Estimated glomerular filtration rate was calculated using the MDRD equation. Patients were grouped according to the WHO clinical stage of HIV disease and the KDIGO CKD stages. The Kruksall-Wallis’s and Dunn’s posts test was used to compare the difference between the PCV and CD4 cell counts of the different groups. Chi-square analysis of the proportions of subjects according to WHO clinical stage of HIV disease at presentation and CKD Stages was also performed. Renal failure (eGFR< 60mL/min) was highly prevalent (13.7%) in the study subjects with a high proportion (90.1%, n=46/51) observed in individuals at Stage 3 and Stage 4 of HIV-disease. A decline in the average packed cell volume (PCV) from CKD stage 1 through 5 and HIV clinical stages1 to 4 was observed, however it was not significant (p < 0.05). Hyperfiltration was observed in 2.9% (11/375) of the study subjects, with a majority (81.8%, 9/11) at HIV clinical stages 3 and 4. The study showed that renal dysfunction is prevalent in HAART naïve HIV-infected individuals at initial diagnosis. Individuals with a CD4 cell count <300cells/mm³ are at a higher risk for renal dysfunction. Thorough evaluation and identification of at risk individuals is imperative.

Key words: Renal Dysfunction, HIV, CKD, CD4, PCV

References

1. Winston J, Deray G, Hawkins T, Szczech L, Wyatt C, Young B. Kidney disease in patients with HIV infection and AIDS. Clinical Infectious Diseases, 2008; 47: 1449 – 14457.

2. Palatini P. Glomerular Hyperfiltration: A marker of early renal damage in pre-diabetes and pre-hypertension. Nephrology Dialysis Transplantation, 2012; 0: 1 – 7.

3. Ando M, Yanagisawa N. Epidemiology, clinical characteristics, and management of chronic kidney disease in human immunodeficiency virus-infected patients. World journal of nephrology, 2015; 4(3): 388 – 395.

4. Schwatz EJ, Szczech LA, Ross MJ, Klotman ME, Winston JA, Klotman PE. Highly-active antiretroviral therapy and epidemic of HIV + end-stage renal disease. Journal of American Society of Nephrology, 2005; 16: 2412 – 2420.

5. Lucas GM, Ross MJ, Stock PG, Slipak MG, Wyatt CM, Gupta SK et al., Clinical Practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases, 2014; 59: 96 – 138.

6. World Health Organization. WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-Related Disease in Adults and Children. http://www.who.int (2007). Accessed 20^th December, 2015.

7. Cooper RD, Natasha W, Smith N, Philip K, Saraladevi N, Marcello T. Systematic Review and Meta-analysis: Renal Safety of TenofovirDisoproxilFumarate in HIV-Infected Patients. ClinInfec Dis. 2010; 51:496–505.

8. Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsusshita K. The definition, classification and prognosis of chronic kidney disease: a KDIGO Controversies conference report, Kidney International, 2011; 80: 17 – 28.

9. Venkat N, Paolo G, Miotti NP, Anand JD, Kline LM, Harmston C, et al HIV and Noncommunicable Disease Comorbidities in the Era of Antiretroviral Therapy: A Vital Agenda for Research in Low- and Middle-Income Country Settings. J Acquir Immune DeficSyndr 2014; 67:S2 – S7

10. Adebayo SB, Olukolade RI, Idogho O, Anyanti J, Ankomah A. Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women. Advances in Infectious Diseases, 2013 3: 210-218.

11. Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bansberg DR, et al. "Impact of HIV-related stigma on treatment adherence: systematic review and meta synthesis," J Int AIDS Soc, 2013; 16 (2), 18640 - 18664

12. Joseph L. Kamalika M, Madhu V, Neeraj KC, Sanjay M. Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population. BMC Pub Health2010, 10:416

13. Choi AI, Li Y, Deeks SG, Grunfeld C, Volberding PA, Shlipak MG. Association between kidney function and albuminuria with cardiovascular events in HIV-infected persons. Circulation, 2010; 121: 651 – 658.

14. Peralta CA, Shlipak MG, Judd S, Cushman M, McClellan W, Zakai NA. Detection of Chronic Kidney Disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end stage renal disease and mortality. JAMA, 2011; 305: 1545 – 1552.

15. Ryom L, Kirk O, Lundgren JD, Reiss P, Pedersen C, De Wit S, Buzunova S. Advanced chronic kidney disease, end-stage renal disease and renal health death among HIV-positive individuals in Europe. HIV Medicine, 2013; 14: 503 – 508.

16. Yanagisawa N, Ando M, Ajisawa A, Imamura A, Suganama A. Clinical Characteristics of kidney disease in Japanese HIV-infected patients. Nephrology Clinical practice, 2011; 118: 285 – 291.

17. Lucas GM, Lau B, Atta MG, Fine DM, Keruly J, Moore RD. Chronic kidney disease incidence and progression to end-stage renal disaes in HIV-infected individuals: a tale of two races, Journal of infectious diseases, 2008; 197: 1548 – 1557.

18. US Renal Data system. USRDS 2007 Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2007.

19. Deeks SG. HIV infection, inflammation, immunosenescence, and aging. Annual Review of Medicine 2011; 62:141–55.

20. Ng DK, Jacobson LP, Brown TT, Palella FJ, Martinson JJ, Bolan R.HIV therapy, metabolic and cardiovascular health are associated with glomerular hyperfiltration in the Multicenter AIDS Cohort Study. AIDS. 2014 January 28; 28(3): 377–386.

21. Lu T-C, He JC, Klotman PE. Podocytes in HIV-associated nephropathy. Nephron ClinPract. 2007; 106: c67–71. [PubMed: 17570932]

22. Chandel N, Sharma B, Husain M, Salhan D, Singh T, Rai P, et al. HIV Compromises Integrity of Podocyte Actin Cytoskeleton through down regulation of Vitamin D receptor. Am J Physiol Renal Physiol Published Online First. Mar 6.2013 doi:10.1152/ajprenal.00717.2012.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search