EFFECTS OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY {HAART} ON THE RENAL FUNCTION OF HIV/AIDS PATIENTS AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN, NIGERIA

Abstract

Background: The effects of HAART on the renal function of newly diagnosed HIV/AIDS
patients attending medical clinics were studied.
Method: One hundred consecutive newly diagnosed HIV/AIDS patients (age 18-59 years)
attending the clinics were recruited for this longitudinal study. Fifty age matched, apparently
healthy, screened blood donors were enrolled for comparison. Blood and spot urine samples
were collected from the patients before HAART treatment, and after 1, 3, 6 and 9 months of
taking HAART and were assayed for creatinine and phosphate. Albumin was analysed only
in urine. The plasma creatinine values were used to determine eGFR (Cockcroft-Gault and
MDRD). UACR was also calculated.
Results: The fifty-five patients had mean age 37.92 ± 10.53(yrs), mean weight 57.47 ±
11.80(kg), mean height 1.63 ± 0.11(m), mean BMI 21.4± 3.74(kg/m2), mean CD4 count of
149.11 ± 116.08 cells/1000mm3. Thirty-five (63.6%) were females while 20 (36.4%) were
males. Fifty age matched apparently healthy subjects were used for comparison.
The creatinine clearance (MDRD) improved from 47.9 ± 18.42 ml/min/1.73m2 for
patients before treatment to 57.9 ± 9.43 ml/min/1.73m2 at 9 months. This was significantly
healthy subjects and pre-treatment subjects’ clearance, disappeared at 9 months. The eGFR
by Cockcroft-Gault did not show any statistically significant difference between pre
treatment and 9 months post treatment values.
The plasma creatinine also improved significantly from the pre-treatment value of
131.1µmol/L to 93.4 µmol/L at 9 months but two patients values increased from 346 and 44
µmol/L to 707 and 563 µmol/L.
The pre-treatment phosphate levels improved significantly from 1.7 ± 0.81 mmol/l to
2.79 ± 2.1 mmol/l (p= 0.001). There was a statistically significant improvement in UACR
from 125.9 ± 271.9 mg/g pre-treatment to 73.3 ± 99.3 mg/g post treatment (p= 0.0001).
Calcium oxalate crystalluria declined from a pre-treatment value of 72.2% to 33%.
Conclusion: Treatment with highly active antiretroviral therapy (HAART) results in obvious
improvement in glomerular and tubular renal functions in previously HAART-naive patients.
The safety profiles of the different HAART combination regimens in this study are also
desirable.