Antiretroviral-naïve, Highly Active Antiretroviral Therapy, Human Immunodeficiency Virus/Acquired immunodeficiency syndrome, Glomerular Filtration Rate.
Abstract
Background: Highly Active Antiretroviral Therapy (HAART) has been implicated in renal toxicity especially in non-Africans. This prospective study was to establish the effects of HAART on glomerular filtration rate in antiretroviral-naïve adult Nigerians with HIV/AIDS. Methods: Eighty-nine patients were treated with HAART: Tenofovir-based (TDF+, n=27); Tenofovir-spared (either Stavudine-based/Stavudine+, n=47; or Zidovudine-based/Zidovudine+, n=15). Diabetes mellitus, hypertension, renal and liver diseases were excluded. Creatinine before HAART and at 1, 3, 6 and 9 months on HAART were used to estimate Glomerular Filtration Rate (eGFR). Results: Mean eGFR at pre-HAART, 1, 3, 6 and 9months post-HAART of patients on TDF+ regimen were 32.53±2.02, ≥60, ≥60, ≥60 and 47.96±1.96ml/min/1.73m2 respectively (p=0.972) with significant difference between pre-HAART and post-HAART means at 1, 3 and 6 except 9 months (p=0.038, 0.038, 0.038, 0.354 respectively). For stavudine+ regimen, eGFR were 36.44±1.56, ≥60, ≥60, ≥60, ≥ 60ml/min/1.73m2 respectively (p=0.000), with significant difference between pre-HAART and post-HAART means (p=0.000, 0.000, 0.000, 0.000 respectively) while for Zidovudine+ patients were 39.97±1.84, 51.76±1.59, ≥60, 59.12±1.04 and 58.40±1.07ml/min/1.73m2 respectively (p=0.704). Sixty-one (68.5%) were females. Fifty-three patients (59.6%) with baseline normal creatinine had reduction by 33.6%. Thirty-three patients, (37.1%) with reduced eGFR at baseline had improved eGFR with their creatinine reduced to normal after 9 months. Two patients (2.2%) with reduced eGFR and elevated creatinine deteriorated on HAART with average creatinine increase of 13.5%. Only one patient, on Stavudine+ regimen experienced toxicity- creatinine, 44µmol/l to 563µmol/l (11.8 folds increase). Conclusion: HAART results in sustained improved glomerular filtration rate after four weeks in antiretroviral-naive patients.
