Sustained Improvement in Glomerular Filtration Rate after Four Weeks on Highly Active Antiretroviral Therapy
Authors
Tewogbade A. Adedeji1, Simeon A. Adebisi2, Adeyinka A. Akande3, Nife O. Adedeji4, Abiodun O. Ajose1, Ademola A. Idowu1, Michael B. Fawale5, Timothy O. Olanrewaju6, Oluyomi Okunola7 and Adewale Akinsola7 1Department of Chemical Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria; 2Department of Chemical Pathology, Benue State University, Makurdi, Nigeria; 3Department of Chemical Pathology, University of Ilorin, Nigeria; 4State Specialist Hospital, Ile-Ife, Nigeria; 5Department of Medicine (Neurology Unit), Obafemi Awolowo University, Ile-Ife, Nigeria; 6Department of Medicine (Renal Unit), University of Ilorin, Nigeria; 7Department of Medicine (Renal Unit), Obafemi Awolowo University, Ile-Ife, Nigeria
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.
