Assessment of renal function among HIV positive patients taking tenofovir and non-tenofovir containing highly active anti retroviral therapy (HAART) at Ayder comprehensive specialized hospital, Mekelle, Ethiopia.
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Date
2020-06
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Addis Abeba University
Abstract
Background: kidney disease is becoming a global burden on public health. The use of HAART
worsens the progression of renal failure in HIV patients. Previous studies have incoherent TDF
outcomes on renal wellbeing.
General objective: To evaluate renal function among HIV positive adult patients taking
tenofovir compared with non-tenofovir containing highly active antiretroviral therapy
(HAART)
Methods: Institutional based cross-sectional comparative study was conducted using a
convenience sampling method from May 20/ 2019 to December /20/ 2019 at ACSH, Mekelle,
Ethiopia. Socio-demographic and clinical characteristics of the study participants were
assessed using medical records, structured questionnaire, anthropometric measuring tools
(electronic weighing scale, adult height board), BDFACA Presto for CD4 determination,
Pentra machine for analyzing renal function was used and the obtained data was analyzed
using SPSS version 25.0.
Result: During the enrolment to HAART, a total of( 9.1%,n=21) respondents had a lowered
GFR level but after the intake of HAART for at least six months, the number of patients with
lowered GFR level raised to 16.8%, n=39(9.5% for the TDF group and 7.3% for the non-TDF
group). Among the total 39(16.8%) declined GFR cases, thirty (12.9%) of study participants
had mild renal dysfunction, 18(81.1%) vs. 12 (70.6%) for TDF and non-TDF groups
respectively. But there was no statistically significant correlation between the severity of renal
dysfunction as described by GFR and the form of HAART regimen (P=0.31). After HAART
initiation, there was no significant mean difference in almost all of the test parameters for renal
function. In those who received TDF-group, renal dysfunction is significantly predicted by
older age ≥50 years, being male, advanced immune-suppression (CD4<200cell/ml) and ≥ 10
years of HAART intake; whereas those on the non-TDF group, renal dysfunction was
significantly predicted by older age ≥50 years and being male.
Conclusion: We found no statistically significant differences in renal dysfunction of HIV
positive patients on TDF and non-TDF containing HAART regimen, but the overall prevalence
of renal dysfunction after six months of HAART follow-up was 16.8%. Therefore, to enhance
the early detection of patients at high risk of kidney failure after initiation of HAART, renal
function of all patients on HAART must be checked regularly by the health care providers.
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Keywords
HAART, TDF, duration of ART, non TDF, renal function test parameters, renal dysfunction, renal safety