dc.description.abstract | ntroduction
As patients infected with human immunodeficiency vi
rus (HIV) live longer while
receiving antiretroviral therapy, kidney diseases h
ave emerged as significant causes
of morbidity and mortality. Black race, older age,
hypertension, diabetes, low CD4+
cell count, and high viral load remain important ri
sk factors for kidney disease in this
population. Chronic kidney disease should be diagno
sed in its early stages through
routine screening and clinicians should pay careful
attention to changes in
glomerular filtration rate or creatinine clearance.
With early detection and treatment,
it is possible to prevent kidney disease and its co
mplications from worsening.
Objectives
:
The broad objective of this study was to evaluate t
he incidence and risk factors of
renal dysfunction in HIV adult patients on Nevirapi
ne based regimens.
Methodology
:
This was a descriptive (right censored arm) hospita
l based retrospective cohort study.
It was carried out at the Kenyatta National Hospita
l Comprehensive Care Center and
targeted HIV patients on Nevirapine based regimens
seen at the KNH-CCC. Data
was collected between May and August 2014. The part
icipants were sampled by
convenient sampling technique. Ethical approval was
obtained from the KNH-UoN
Research and Ethics Committee. Quantitative data wh
ich was obtained from the
patient interviews and abstraction of patient files
was analyzed using STATA version
10 software. Ordered Logistic regression modeling w
as used to identify covariates
that determine the severity of nephrotoxicity.
Results
:
In total, 241 HIV-infected adult patients were incl
uded in this study. There were 56
male and185 female patients. The median age was 39
years [IQR 35-44]. The
duration of follow up for most of the patients was
5 years.
The prevalence of renal
dysfunction
at baseline was 6.3% and the incidence in the study
was 4.3%. In this study ive (2.1%) patients had estimated GFR (eGFR)
<
50
mL/min per 1.73
m
2
, while ten
(8.3%) patients had elevated serum creatinine (abov
e 120μ g/l). In the multivariate
ordered logistic regression the significant predict
or variables for renal dysfunction
that were significant were age at diagnosis, curren
t age at the time of study, the sex,
alcohol consumption and the duration of therapy.
The females had a higher risk of developing renal d
ysfunction (adjusted O.R 0.48
(95% C.I 0.24-1.04) p=0.04). Alcohol consumption wa
s a significant predictor of
renal dysfunction (adjusted O.R 1.84 (95% C.I 1.01-
3.29) p=0.04).
Intensity of
alcohol consumption has not been reported as a pred
ictor of renal disease in HIV
patients on HAART. This is the first study to repor
t alcohol use as a risk factor.
Conclusion and Recommendation
:
Renal dysfunction might occur in HIV patients on ne
virapine based regimens
evidenced by the incidence of 4.3%. The risk factor
s identified in this study include
age at diagnosis, alcohol consumption, duration of
therapy and the female gender.
The elevated serum creatinine level at baseline is
a key indicator in the management
of renal dysfunction. Routine eGFR calculations sho
uld be done at each clinical visit.
Early detection and vigilant monitoring is require
d for patients with the known risk
factors; systematic screening and appropriate refer
rals for kidney disease
management should be advocated for improved patient
care. Larger studies
comparing the contribution of other NNRTIs is recom
mended | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |