A STUDY OF RENAL ABNORMALITIES IN HIV INFECTED PATIENTS AND ITS CORRELATION WITH CD4 COUNT AND ART REGIMEN
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Keywords
HIV, Tenofovir, Chronic kidney disease, Proteinuria, CD4 count, eGFR, Creatinine clearance
Abstract
Renal disease is a recognized complication of HIV infection, with chronic kidney disease (CKD) prevalence reported between 3.5% and 32.6%. Tenofovir disoproxil fumarate (TDF) has been associated with nephrotoxicity, and lower CD4 counts are linked to higher risk of renal impairment. Early identification of renal dysfunction in HIV-positive individuals is critical for timely intervention.
Objectives: To determine the prevalence of renal damage in the form of proteinuria and reduced creatinine clearance/eGFR in HIV-infected patients, and to assess its correlation with antiretroviral therapy (ART) regimen and CD4 T-cell count.
Methods: This cross-sectional observational study included 300 HIV-positive patients (aged 18–70 years) attending a tertiary care hospital. Data collected included demographics, ART regimen, CD4 count, urine analysis, 24-hour urine protein, and renal function tests. Creatinine clearance (Cockcroft–Gault) and eGFR (MDRD) were calculated. Patients were categorized based on ART regimen (TDF-based vs. zidovudine [AZT]-based) and CD4 count (<200, 200–350, >350 cells/µl).
Results: Of 300 patients, 196 (65.33%) were male; mean age was ~39 years. TDF-based regimen was used in 158 (52.6%) patients, AZT-based in 120 (40%), and 22 (7.3%) were not on ART. Proteinuria was present in 24% of patients, significantly higher in the TDF group (88.9%) than AZT group (13.8%) (p<0.05).
Conclusion: Proteinuria and reduced renal function are common among HIV-infected patients, particularly in those on TDF-based regimens and with CD4 counts <200 cells/µl. Regular renal function monitoring is recommended at diagnosis and quarterly for patients on TDF or with advanced HIV disease.
References
2. Huet T, Cheyneir R, Meyerhans A. Genetic organization of a chimpanzee lentivirus related to HIV-1. Nature 1990; 345:356-9.
3. Weiss RA. How does HIV cause AIDS?. Science. 1993 May 28;260(5112):1273-9.
4. Douek DC, Roederer M, Koup RA. Emerging concepts in the immunopathogenesis of AIDS. Annual review of medicine. 2009;60(1):471-84.
5. Gupta SK, Eustace JA, Winston JA, Boydstun, II, Ahuja TS, Rodriguez RA, et.al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2005; 40:1559-85.
6. Schwartz EJ, Szczech LA, Ross MJ, Klotman ME, Winston JA, Klotman PE. Highly active antiretroviral therapy and the epidemic of HIV+end-stage renal disease . J Am Soc Nephrol. 2005;16(8):2412-20.
7. Choi AI. HIV and kidney disease. HIV InSite Knowledge Base Chapter. San Francisco: University of California San Francisco, San Francisco General Hospital; 2003 No
8. Shubhanker Mitra 1, Rupali Priscilla2, Rajeev Karthik3, Sauradeep Sarkar4, S Rajkumar5,Abraham O Cherian. Renal Tubular Dysfunction Associated with Tenofovir Therapy. J Assoc Physicians India. 2014;62:580-2.
9. Szczech LA, Gange SJ, Van Der Horst C, Bartlett JA, Young M, Cohen MH et.al. Predictors of proteinuria and renal failure among women with HIV infection. Kidney Int. 2002;61(1):195-202.
10. Zhu T, Korber BT, Nahmias AJ, Hooper E, Sharp PM, Ho DD. An African HIV-1 sequence from 1959 and implications for the origin of the epidemic. Nature. 1998;391(6667):594-7.
11. Longo DL, Fauci AS, Kasper DL, Jameson JL, Hauser SL, Loscalzo J, et al. HARRISON‘S PRINCIPLES OF INTERNAL MEDICINE; Vol 1.18th edition. New York: McGraw Hill Inc, 2012:1506-41.
12. Mack M, Kleinschmidt A, Brühl H, Klier C, Nelson PJ, Cihak J, et.al. Transfer of the chemokine receptor CCR5 between cells by membrane-derived microparticles: a mechanism for cellular human immunodeficiency virus 1 infection. Nature medicine. 2000 Jul;6(7):769-75.
13. Rieke A. HIV and renal abnormalities. HIV Med. 2007;8(1):1-8.
14. Takalkar AA, Saiprasad GS, Prasad VG, Madhekar NS. Study of opportunistic infections in HIV seropositive patients admitted to community care centre (CCC), KIMS Narketpally. Biomed Res. 2012;23(1):139-42.
15. Jacobson LP et al: Proteinuria among HIV infected HAART recipients in the multicenter AIDS cohort study (MACS). MJA. 2007
16. Longenecker CT, Scherzer R, Bacchetti P, Lewis CE, Grunfeld C, Shlipak MG. HIV viremia and changes in kidney function. AIDS. 2009;23(9):1089-96.
17. Wools-Kaloustian K1, Gupta SK, Muloma E, Owino-Ong'or W, Sidle J, Aubrey RW, et.al, Goldman M. Renal disease in an antiretroviral-naïve HIV-infected outpatient population in Western Kenya, Nephrol Dial Transplant. 2007;22(8):2208-12
18. Fakhrul Islam, Jianyun Wu, James Jannson and David P Wilson : Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis. BMC Public Health 2012,12:234.
19. Scarpino M, Pinzone MR, Di Rosa M, Madeddu G, Foca E, Martellotta F, et.al. Kidney disease in HIV-infected patients. Eur Rev Med Pharmacol Sci. 2013;17(19).
20. Emem CP, Arogundade F, Sanusi A, Adelusola K, Wokoma F, Akinsola A. Renal disease in HIV-seropositive patients in Nigeria: an assessment of prevalence, clinical features and risk factors. Nephrol Dial Transplant. 2008;23(2):741-6.
21. Winston A, Amin J, Mallon PW, Marriott D, Carr A, Cooper DA, et.al. Minor changes in calculated creatinine clearance and anion‐gap are associated with tenofovir disoproxil fumarate‐containing highly active antiretroviral therapy. HIV medicine. 2006;7(2):105-11.
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Dr Astha Ganeriwal
Assistant Professor, General Medicine. Government Medical College, Jalgaon
Dr R A Ganeriwal
Assistant Professor, General surgery, Dr Rajendra Ghode Medical college, Amravati
Dr Aparna Garg
Professor and Head, Department of Physiology, Mahatma Gandhi Medical College and Hospital, Jaipur