Assessment of Renal Function in Hiv/Aids Patients on Highly Active Antiretroviral Therapy (Haart) In Abuth, Zaria
Assessment of Renal Function in Hiv/Aids Patients on Highly Active Antiretroviral Therapy (Haart) In Abuth, Zaria
ABSTRACT
Acquired immunodeficiency syndrome (AIDS) is a spectrum of disease states characterised by progressive immunosuppression.
It results from infection with Human Immunodeficiency Virus (HIV) which is capable of affecting every organ system in the body.
Renal complications are important component of advanced HIV disease, and these complications significantly contribute to morbidity and mortality in these patients.
Therefore, regular assessment of their renal status using sensitive markers such as Creatinine Clearance (CrCl) together with serum electrolytes, creatinine, urea and uric acid is necessary.
The objective of this study was therefore to assess the renal function, determine the appropriate assessment parameters and the prevalence of renal disease among HIV/AIDS patients on highly active antiretroviral therapy (HAART) in ABUTH, Zaria.
Renal function of 101 HIV positive patients on HAART and 100 controls was assessed. The data obtained were analysed using statistical programme for the social sciences 11.0 (SPSS 11.0).
Two-tailed student׳s t-test for matched samples and Pearson’s linear correlation statistical methods were employed for the analysis.
TABLE OF CONTENTS
Title page………………………………………………………………………..ii
Declaration……………………………………………………………………..iii
Certification by Head of Department…………………………………………..iv
Certification……………………………………………………………………..v
Dedication………………………………………………………………………vi
Acknowledgement……………………………………………………………..vii
Abstract…………………………………………………………………………ix
Table of contents………………………………………………………………..xi
List of tables…………………………………………………………………xviii
List of figures………………………………………………………………….xix
List of appendices………………………………………………………………xx
Abbreviations/Symbols used………………………………………………….xxi
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background……………………………………………………………..1
1.1.1 HIV and Renal disease. …………………………………………. ……..2
1.2 Statement of problem…………………………………………. ………..4
1.3 Justification…………………………………………………… ………..5
1.4 General objective………………………………………………………..5
1.5 Specific objectives………………………………………………………….6
CHAPTER TWO
2.0LITERATURE REVIEW
2.1 Human Immunodeficiency Virus………………………………………7
2.1.1 Brief history……………………………………………………….. ….7
2.1.2 Epidemiology………………………………………………………….8
2.1.3 Biology of the virus………………………………………………..….10
2.1.4 Viral structure……………………………………………………… …11
2.1.5 Molecular epidemiology of HIV………………………………………14
2.1.6 Mode of transmission…………………………………………………15
2.1.6.1 Sexual intercourse (Homosexual/Heterosexual)………………………15
2.1.6.2 Parenteral transmission………………………………………………15
2.1.6.3 Vertical transmission………………………………………………….16
2.1.6.4 Certain traditional practices in our environment……………………..16
2.1.7 Pathogenesis………………………………………………………….16
2.1.7.1 Natural history of HIV infection…………………………………….20
2.1.8 Diagnosis……………………………………………………………..23
2.1.8.1 Laboratory diagnosis…………………………………………………24
2.1.9 Management………………………………………………………….25
2.1.9.1 Classes of drugs………………………………………………………26
2.1.9.2 Limitations of antiretroviral drug therapy……………………………28
2.1.9.3 Side effects……………………………………………………………28
2.2 The Kidney…………………………………………………………..30
2.2.1 Functions of the kidney………………………………………………32
2.2.2 Classification of kidney failure………………………………………34
2.2.2.1 Acute renal failure (ARF)……………………………………………34
2.2.2.2 Chronic kidney disease (CKD)………………………………………35
2.2.3 Assessment of renal function………………………………………..41
2.2.3.1 Glomerular dysfunction……………………………………………..42
2.2.3.2 Tubular dysfunction…………………………………………………43
2.2.3.3 Creatinine……………………………………………………………45
2.2.3.3.1 Creatinine clearance (CrCl)…………………………………………45
2.2.3.4 Urea………………………………………………………………….46
2.2.3.5 Prediction formulas………………………………………………….46
2.2.3.5.1 Cockcroft and Gault equation………………………………………46
2.2.3.5.2 MDRD formula……………………………………………………..47
2.3 HIV and renal function………………………………………………48
2.3.1 Pathogenesis of renal disease in HIV/AIDS…………………………50
2.4 Renal disease in HIV/AIDS…………………………………………53
CHAPTER THREE
3.0 SUBJECTS AND METHODS
3.1 Background of study area…………………………………………..56
3.2 Study population (Subjects)………………………………………..56
3.2.1 Inclusion criteria……………………………………………………56
3.2.2 Exclusion criteria……………………………………………………57
3.2.3 Consent……………………………………………………………..57
3.2.4 Sample size…………………………………………………………57
3.2.5 Ethical approval……………………………………………………58
3.3 Study protocol………………………………………………………58
3.4 Specimen collection and processing…………………………………59
3.4.1 Blood………………………………………………………………..59
3.4.2 Urine………………………………………………………………………59
3.5 Chemicals……………………………………………………………59
3.6 Equipment……………………………………………………………60
3.7 Analytical methods………………………………………………….60
3.7.1 Creatinine……………………………………………………………60
3.7.1.1 Principle…………………………………………………………….61
3.7.1.2 Procedure…………………………………………………………..61
3.7.1.3 Calculation………………………………………………………….61
3.7.2 Urea…………………………………………………………………62
3.7.2.1 Principle ……………………………………………………………62
3.7.2.2 Procedure……………………………………………………………62
3.7.2.3 Calculation…………………………………………………………..63
3.7.3 Sodium and potassium……………………………………………63
3.7.3.1 Principle……………………………………………………………63
3.7.3.2 Procedure…………………………………………………………..63
3.7.3.3 Calculation…………………………………………………………64
3.7.4 Chloride……………………………………………………………64
3.7.4.1 Principle……………………………………………………………64
3.7.4.2 Procedure……………………………………………………………65
3.7.4.3 Calculation…………………………………………………………65
3.7.5 Bicarbonate………………………………………………………..65
3.7.5.1 Principle……………………………………………………………65
3.7.5.2 Procedure………………………………………………………….65
3.7.5.3 Calculation…………………………………………………………66
3.7.6 Calcium……………………………………………………………66
3.7.6.1 Principle……………………………………………………………66
3.7.6.2 Procedure…………………………………………………………..66
3.7.6.3 Calculation………………………………………………………..67
3.7.7 Inorganic phosphorus…………………………………………….67
3.7.7.1 Principle…………………………………………………………..67
3.7.7.2 Procedure…………………………………………………………68
3.7.7.3 Calculation………………………………………………………..68
3.7.8 Uric acid…………………………………………………………..69
3.7.8.1 Principle…………………………………………………………..69
3.7.8.2 Procedure…………………………………………………………69
3.7.8.3 Calculation………………………………………………………..69
3.7.9 Quality control…………………………………………………….70
3.8 Urinalysis…………………………………………………………70
3.8.1 Principle…………………………………………………………..70
3.8.1.1 Urobilinogen………………………………………………………70
3.8.1.2 Glucose……………………………………………………………71
3.8.1.3 Bilirubin…………………………………………………………..71
3.8.1.4 Ketones……………………………………………………………71
3.8.1.5 Specific gravity……………………………………………………71
3.8.1.6 Occult blood……………………………………………………….72
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3.8.1.7 pH…………………………………………………………………72
3.8.1.8 Protein…………………………………………………………….72
3.8.1.9 Nitrite……………………………………………………………..72
3.8.1.10 Leucocytes………………………………………………………..73
3.8.2 Procedure………………………………………………………….73
3.9 Statistical analysis……………………………………………….73
CHAPTER FOUR
4.0 RESULTS
4.1 Analysis of study population…………………………………………75
4.2 Anthropometric measurements in HIV/AIDS patients on HAART
and controls……………………………………………………………76
4.3 Serum electrolytes in HIV/AIDS patients on HAART and controls…79
4.4 Estimated creatinine clearance (eCrCl), serum creatinine, urea
and uric acid in HIV/AIDS patients on HAART and controls………81
4.5 Relationship between serum electrolytes and duration on HAART
in HIV/AIDS patients…………………………………………………84
4.6 Relationship between duration on HAART and eCrCl, serum
creatinine, urea and uric acid in HIV/AIDS patients………………..84
4.7 Relationship between duration on HAART and body mass index
(BMI) in HIV/AIDS patients…………………………………………88
4.8 Relationship between eCrCl and BMI in HIV/AIDS patients
and controls……………………………………………………………88
4.9 Relationship between eCrCl and serum creatinine in HIV/AIDS
patients and controls………………………………………………….92
4.10 Urinalysis in the study population…………………………………..95
CHAPTER FIVE
5.0 DISCUSSION………………………………………………………..97
CONCLUSION………………………………………………………103
RECOMMENDATIONS……………………………………………105
REFERENCES………………………………………………………107
APPENDICES……………………………………………………….121
INTRODUCTION
Acquired Immunodeficiency Syndrome (AIDS) is a spectrum of disease states characterised by progressive immunosuppression.
It results from infection with the Human Immunodeficiency Virus (HIV) (Cotran et al, 1999; Olumide, 2003). HIV infection is a worldwide health problem that affects millions of men and women (Jeff, 2002).
Since the beginning of the pandemic in the early 1980, more than 60million people have been infected with HIV worldwide, with an estimated 25million death, and 5million new infection each year.
Sub-saharan Africa carries the highest burden of HIV infection with an estimated prevalence of more than 80% of the world cases (AIDS epidemic update, 2002).
In Nigeria, the prevalence of HIV infection continues to rise from 1.8% in 1991 to 5.8% in 2001, and about 3.5million Nigerians were reported to be infected with HIV virus in 2002 (National AIDS/HIV/STD Control programme, 1997, 1999, 2000, 2002, 2003).
The high prevalence in 2002 put Nigeria as the second in the world with the national sero-prevalence of 5.4% of HIV infection (Idoko et al, 2002).
REFERENCES
Abobott KC, Hypolite I and Welch PG (2001): Human immunodeficiency virus/acquired immunodeficiency syndrome-associated nephropathy at endstage renal disease in United States:
Adrouge HJ and Madias NE (1981): Changes in plasma potassium concentration during acute acid-base disturbances. Am. J. Med., 71: 456-467.
Afonja OA (2004): Basic Clinical Biochemistry practice.1st edition, pp. 78-99.
Agaba EI, Agaba PA, Sirisena ND, Anteyi EA and Idoko JA (2003): Renal Diseases in the Acquired Immunodeficiency Syndrome in North Central Nigeria. Nig. J. of Med., 12(3): 120-125.
AIDS Clinical Care (2007): The Spectrum of HIV-Associated Renal Disease – Journal Watch. vol.4.
AIDS epidemic update (2002): UNAIDS/WHO.
