Study of Renal Functions in People Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (PLHA): An Observational Study of Tertiary Care Hospital in North India
Takhe Takung *
Department of Medicine, University College of Medical Sciences and G.T.B. Hospital, Dilshad Garden, Delhi -110095, India.
Pawan Kumar Kare
Department of Biochemistry, Biochemistry and Immunology Laboratory, University College of Medical Sciences and G.T.B. Hospital, Dilshad Garden, Delhi -110095, India.
Om Prakash Kalra
Department of Medicine, University College of Medical Sciences and G.T.B. Hospital, Dilshad Garden, Delhi -110095, India.
Sunil Agarwal
Department of Medicine, University College of Medical Sciences and G.T.B. Hospital, Dilshad Garden, Delhi -110095, India.
Kuldeep Kumar
Department of Medicine, ART Clinic, University College of Medical Sciences and G.T.B. Hospital, Dilshad Garden, Delhi -110095, India.
Sonal Sharma
Department of Pathology, University College of Medical Sciences and G.T.B. Hospital, Dilshad Garden, Delhi -110095, India.
Ashok Kumar Tripathi
Department of Biochemistry, Biochemistry and Immunology Laboratory, University College of Medical Sciences and G.T.B. Hospital, Dilshad Garden, Delhi -110095, India.
*Author to whom correspondence should be addressed.
Abstract
Aims: The aim of this study was to find out the involvement of renal dysfunction in people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLHA) in India.
Study Design: Observational study.
Place and Duration of Study: Total (n=150) consecutive HIV positive patients between November 2012 - April 2014, who were attending the ART Clinic or were admitted in Department of Medicine at University College of Medical Sciences and Guru TegBahadur Hospital, Delhi, India were recruited for the study.
Methodology: Estimated glomerular filtration rate (eGFR) was calculated by using Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Morning spot urine samples were collected for urine albumin and urine creatinine test. Albumin/creatinine ratio (ACR) was calculated by using urine albumin and urine creatinine and were expressed in mg/g creatinine.
Results: The mean eGFR (MDRD) of the study subjects was found 106.8±20.72 mL/min/1.73 m2 and a statistically significant difference was observed between male and female subjects (p = 0.039). The mean eGFR (CKD-EPI) of the study subjects was found 107.53±18.50 mL/min/1.73 m2, however, no significant difference was observed between male and female subjects (p = 0.745). The micro/macro-albuminuria (urinary ACR ≥ 30 mg/g creatinine) was found in 18 (12%) patients and leucocyturia and hematuria was found in 12.7% and 5% patients respectively. The median CD4 counts of the study subjects was 341 (222-467) cells/ mm3 and 141 (94%) were taking highly active anti-retroviral therapy (HAART). The most common HAART regimens were zidovudin/ lamivudine/nevirapine (ZLN) and tenofovir/ lamivudine/ nevirapine (TLN); 60.7% & 26.0% respectively. Hepatitis B and C co-infection rate found among subjects was 4% and 3.3% respectively.
Conclusions: In conclusion, the prevalence of deranged renal functions as indicated by eGFR and urinary ACR is common in PLHA in North India. All HIV infected patients must undergo renal function tests including urinary ACR to detect the renal involvement at early stage.
Keywords: Human immunodeficiency virus, acquired immune deficiency virus, albumin/creatinine ratio.