Kidney Dysfunction in HIV-Positive Patients on HAART In a Nigerian Tertiary Hospital: A Comparative Study

Background: There has been improvement in the overall outcomes of people living with human immunodeficiency virus (PLWHIV) following the advent and use of highly active antiretroviral therapy (HAART). However, there is an increased risk of nephrotoxicity from using HAART in PLWHIV as their life expectancy improves. This study assessed and compared renal dysfunction among PLWHIV on tenofovir-based and non-tenofovir-based HAART.

Methodology: This comparative cross-sectional study determined and compared glomerular and tubular dysfunction among PLWHIV on tenofovir-based and non-tenofovir-based HAART. Urine beta2-microglobulin, fractional excretion of bicarbonate, uric acid, and Phosphate were used to assess proximal tubular function. The modification of diet in renal disease (MDRD) formula was used to estimate the glomerular filtration rate (eGFR).

Result: There were 120 participants with a mean age of 42.2 ±9.2 years. Sixty participants were on tenofovir-based HAART, and 60 were on non-tenofovir-based HAART. The overall prevalence of proximal renal tubular dysfunction among PLWHIV on HAART was 9.1%. The proximal renal tubular dysfunction prevalence was higher in the tenofovir-based group (15.0%vs3.3% P= 0.01). The mean urine β₂ MG level was higher in the tenofovir-based HAART group (0.21±0.15ug/ml vs 0.14±0.12ug/ml; P= 0.01). The mean eGFR was lower in the tenofovir-based HAART group (86.99±18.51mls/min/1.73m² vs 99.59±34.48mls/min/1.73m²; P=0.01).

Conclusion: Tenofovir-based HAART was associated with a significant decrease in GFR and proximal renal tubular dysfunction compared to non-tenofovir-based HAART. Those on tenofovir should be regularly monitored with markers of tubular dysfunction.