Effects Of Highly Active Antiretroviral Therapy On The Liver And Kidney Functions In Hiv Patients At Coast Province General Hospital, Kenya

ABSTRACT

The emergence of highly active antiretroviral therapy (HAART) has led to dramatic improvements in prolonging survival of HIV-infected patients on treatment in resource-limited areas. However, the main drawback of HAART that long-term use has the potential to cause liver and kidney derangements that may be life-threatening. These important complications sometimes warrant switch or discontinuation of antiretroviral therapy. Information on the prevalence of the above complications in Kenya is scanty. The current study assessed the prevalence of hepatic and renal toxicity in one hundred and fifty HIV+ patients [50 HAART naïve and 100 HAART treated subjects] based on clinical laboratory assays. Data were matched for HAART status, age, sex and the duration the patients had been on ARV treatment. The data was analyzed using SAS version 9.2. The prevalence of hepatotoxicity based on elevated alanine aminotransferase analyte above upper limit of normal was 18% in HAART treated and 8% in HAART naïve patients. The prevalence of renal derangements based on elevated creatinine analyte above upper limit of normal was 4% in HAART treated and 8% HAART naïve group. However, the prevalence of hepatotoxicity and renal derangements cases did not vary significantly between HAART treated and HAART naïve subjects (χ2; P =0.59 and P = 0.9 respectively). Variation in liver and kidney analytes were compared between gender using student’s t-test and variation in data for liver and kidney analytes were compared for age and duration the patients were on HAART using ANOVA with statistical significance set at α=0.05. The key liver and kidney analytes indicative of hepatotoxicity and renal insufficiency varied significantly between males and females; (ALT; P=0.001) and (CREAT; P=0.001) respectively. Liver and kidney analytes varied significantly with age; (ALT; P=0.006) and (CREAT: P=0.001) respectively and the duration the patients had been on HAART; (ALT; P=0.002) and (CREAT; P=0.001) respectively. In conclusion, prevalence of hepatotoxicity was 17.3% and renal insufficiency was 5.3% in all HIV positive subjects irrespective of HAART status. The prevalence of hepatotoxicity was higher in the HAART treated, female gender, patients aged above 46 years or have been on HAART for more than 4 years. Renal insufficiency was more common in HAART naïve patients, female gender, and patients aged more than 46 years. Results from this study will help healthcare actors and providers to pay greater attention to individualized treatment of HIV and AIDS using HAART so as to reduce toxicities and co-morbidities that reduce the quality of life and increases the risk of death. They can also help in harmonizing HAART regimens and prescription dosage in order to reduce toxicity levels. The study recommends a controlled research study to be carried out to tease out toxic individual drug agents within HAART classes on liver and kidney functions.