Evaluation of the Impact of Antiretroviral Therapy (ART) on Renal Function in HIV Positive Patients Receiving HIV treatment at Federal Medical Centre, Makurdi, Nigeria

Introduction: The management of HIV involves the lifelong administration of Antiretroviral Therapy (ART), which includes drugs with a known history of nephrotoxicity. Despite the widespread use of ART, there remains a significant gap in understanding its long-term effects on kidney function. This study seeks to address this knowledge gap by examining how prolonged use of ART regimens impacts renal indices in HIV-infected patients attending the APIN clinic at the Federal Medical Centre, Makurdi.

Method: This was a hospital-based case-control study that included both HIV positive and negative patients who attended the APIN clinic, Federal Medical Centre Makurdi during the study period. Sociodemographic characteristics and some clinical variables were collected using self-administered structured questionnaires. Blood samples were collected from respondents using standard phlebotomy protocol. Renal impairment was classified in accordance with the National Kidney Foundation clinical practice guideline. Glomerular Filtration Rate was calculated using the 24-hour creatinine clearance method. Blood urea nitrogen was calculated from serum urea concentrations. Values were compared between the two groups using chi-square and independent sample T-test at 95% Confidence level using SPSS version 26.0

Result: Prevalence of renal impairment was 25.6% in HIV positive patients. creatinine clearance (Crcl) and estimated Glomerular Filtration Rate (eGFR) were significantly decreased in HIV respondents on ART compared to the control group (baseline) with values of (62.0ml/min/1.73m2) and (66.09ml/min) respectively, while the BUN was elevated in the HIV-positive respondents compared to the control group (15.71mg/dl). Proteinuria was 8% in the HIV group. Creatinine (99.0umol/L), Urea (5.6mmol/L) HCO3 (26.9mmol/L), Cl- (105.2mmol/L) were all significantly elevated in the HIV positive group, but fell within normal range (P<0.05). While Na+ and K+ had same levels in both group (p>0.05) and were within normal reference range for study population.

Conclusion: Respondents on ART for at least two years or more had decreased renal function, renal indices showed a significant decrease in Crcl and eGFR indicating an association of renal function with prolonged use of ART in HIV-positive respondents. Further study is required to ascertain specific ART combinations associated with these findings.