Characteristics and Associations of Renal Dysfunction at Presentation in Haart-Naïve HIV-Infected Subjects in Port Harcourt, Nigeria

Abstract

Renal impairment is a major concern for HIV-infected individuals. It affects the way of life of the patients and could lead to a poor prognosis during the course of treatment. A retrospective study of 375 newlydiagnosed HAART naive HIV-infected individuals from April 2014 to April 2015 was carried out. Information collected from the patients’ hospital folders include: Data and reports of biochemical and hematological investigations. Estimated glomerular filtration rate was calculated using the MDRD equation. Patients were grouped according to the WHO clinical stage of HIV disease and the KDIGO CKD stages. The Kruksall-Wallis’s and Dunn’s posts test was used to compare the difference between the PCV and CD4 cell counts of the different groups. Chi-square analysis of the proportions of subjects according to WHO clinical stage of HIV disease at presentation and CKD Stages was also performed. Renal failure (eGFR< 60mL/min) was highly prevalent (13.7%) in the study subjects with a high proportion (90.1%, n=46/51) observed in individuals at Stage 3 and Stage 4 of HIV-disease. A decline in the average packed cell volume (PCV) from CKD stage 1 through 5 and HIV clinical stages1 to 4 was observed, however it was not significant (p < 0.05). Hyperfiltration was observed in 2.9% (11/375) of the study subjects, with a majority (81.8%, 9/11) at HIV clinical stages 3 and 4. The study showed that renal dysfunction is prevalent in HAART naive HIV-infected individuals at initial diagnosis. Individuals with a CD4 cell count <300cells/mm 3 are at a higher risk for renal dysfunction. Thorough evaluation and identification of at risk