Renal Function among HIV Infected Patients on Combination Antiretroviral Therapy: A Longitudinal Cohort Study

Introduction: A large number of Human Immunodeficiency Virus (HIV) infected patients are taking combination Antiretroviral Therapy (cART) worldwide as it has led to dramatic improvements in them with a decreased viral load as well as an increase in CD4+ (Cluster of Differentiation) T cell count. Though the incidence of HIV associated Chronic Kidney Disease (CKD) has decreased with the use of effective cART, the prevalence of End Stage Renal Disease (ESRD) in HIV positive patients has increased due to the risen longevity owing to them. Aim: To study the renal function abnormalities in HIV infected patients and to compare the change in renal function of treatment naive patients with patients on triple drug regimen (cART). Materials and Methods: This prospective longitudinal cohort study was conducted on 54 Enzyme Linked Immunosorbent Assay (ELISA) positive HIV patients belonging to the age group of 18-70 years of both the genders over a period of two years from August 2017 to September 2019 in MKCG Medical College and Hospital, Berhampur, Odisha, India. Forty nine HIV infected patients naive to cART and five patients on cART for a minimum period of three months were included in this study. Patients known to have Acute Kidney Injury (AKI) or CKD, diabetes mellitus, hypertension, pregnancy, Hepatitis B surface Antigen (HBsAg) positive, Hepatitis C Virus antibody (HCV Ab) positive and taking nephrotoxic drugs were excluded. All patients were treated with triple therapy regimens of either ZLN (Zidovudine 300 mg+Lamivudine 150 mg+Nevirapine 200 mg) or TLE (Tenofovir 300 mg+Lamivudine 150+Efavirenz 600 mg) daily; in a single dose at bed time. Renal function parameters like serum urea, serum creatinine, Creatinine Clearance (CrCl), estimated Glomerular Filtration Rate (eGFR) and CD4+ T cell count of treatment naive patients were compared with the same patients on cART after six months duration. GFR was calculated by Modification of Diet in Renal Disease (MDRD) equation. Results were analysed using the Statistical Package for the Social Sciences (SPSS) software for Windows Version 17.0. Results: Out of 54 patients, 53.7% (n=29) were males and 46.3% (n=25) were females. The mean CrCl of HIV positive patients on cART (79.09 +/- 25.705 mL/min) was higher than treatment naive (69.65 +/- 25.506 mL/min) patients and was highly significant (p=0.003). The mean eGFR of HIV positive patients on cART (102.711 +/- 26.9424 mL/min/1.73 m(2)) was higher than treatment naive (90.189 +/- 28.2575 mL/min/1.73 m2) patients and was highly significant (p= 0.003). The mean serum urea of HIV positive patients on cART (25.78 +/- 4.721 mg/dL) was lower than HIV positive treatment naive (26.19 +/- 4.742 mg/ dL) patients but was non-significant (p=0.640). The mean serum creatinine of HIV positive patients on cART (0.815 +/- 0.1393 mg/dL) was lower than HIV positive treatment naive patients (0.906 +/- 0.1687 mg/dL) and was also highly significant (p=0.003). The mean CD4+ T cell count of HIV positive patients on cART (401.63 +/- 225.816 cells/mu L) was higher than HIV positive treatment naive (287.13 +/- 198.263 cells/mu L) patients and was very highly significant (p=0.001). Conclusion: Renal impairment (CrCl <60 mL/min) and eGFR (<60 mL/min/1.73 m(2)) were higher in HIV positive treatment naive patients than those on cART. Radiological parameters like size of the kidney and cortical echogenicity became normal after six months on cART.