Assessment of the effect of antiretroviral therapy on renal and liver functions among HIV-infected patients: a retrospective study Suppression of HIV-1 replication by antiretroviral therapy improves renal function in persons with low CD4 cell counts and chronic kidney disease
Background The emergence of highly active antiretroviral therapy ( HAART ) has dramatically improved quality of life in prolonging survival of human immunodeficiency virus (HIV)-infected patients on treatment in developed as well as developing countries . However , the main shortcoming of HAART in long-term use is its potential to cause liver and kidney derangements that may be life threatening . The drugs are actively accumulated in the proximal renal tubule result ing in functional disturbance with mitochondrial injury being one of the most important targets recognized . Therefore , the aim of this study was to assess the adverse effects of HAART on kidney and liver functions among HIV-infected patients presenting to the University of Gondar Hospital , Ethiopia . Material s and methods An institution-based retrospective study was conducted from 2010 to 2015 on a subset of HIV-infected patients . Data were collected from the registration book of the University of Gondar Hospital antiretroviral clinic laboratory after checking the completeness of age , gender , creatinine , blood urea nitrogen , and alanine aminotransferase level . Data were entered and analyzed using SPSS version 20 . Descriptive statistics , chi-square test , one-way analysis of variance , and logistic regression were done to determine associations . A P-value < 0.05 was considered statistically significant . Results A total of 275 study subjects were included in the study . Of these , 62.2 % were females , and the overall prevalence of chronic kidney disease ( CKD ) before and after treatment was 3.6 % and 11.7 % , respectively . A majority of the CKD patients were in stage 3 for patients after treatment . The overall prevalence of hepatotoxicity was 6.5 % and 16.7 % before and after treatment , respectively . A majority of the patients developed Grade 2 hepatotoxicity 66.7 % and 65.2 % before and after treatment , respectively . Binary and multiple logistic regression analysis indicated that the female gender was a risk factor for CKD . Conclusion The prevalence of nephrotoxicity and hepatotoxicity were high among patients who took HAART . Stage 3 nephrotoxicity and Grade 2 hepatotoxicity had the highest incidences of the total toxicities , and the female gender was a risk factor for nephrotoxicity . Further prospect i ve studies are recommended to determine the effect of HAART and contributing factors Objective : To examine the association between changes in glomerular filtration rates ( GFR ) and  antiretroviral therapy (ART)-mediated  suppression of plasma HIV-1 viremia . Design : Observational , prospect i ve , multicenter cohort study . Intervention : ART regimens or treatment strategies in HIV-1-infected subjects were implemented through r and omized clinical trials ; 1776 ambulatory subjects from these trials also enrolled in this cohort study . Method : The association between suppression of viremia and GFR changes from baseline was examined using the abbreviated Modification of Diet and Renal Disease equation in mixed effects linear models . Results : GFR improvement was associated with ART-mediated suppression of plasma viremia in subjects with both chronic kidney disease stage ≥ 2 and low baseline CD4 cell counts ( < 200 cells/μl ) . In this subset , viral suppression ( by > 1.0 log10 copies/ml or to < 400 copies/ml ) was associated with an average increase in GFR of 9.2 ml/min per 1.73 m2 from baseline ( 95 % confidence interval , 1.6–16.8 ; P = 0.02 ) over a median follow-up of 160 weeks . The magnitude of this association increased in subjects who had greater baseline impairment of renal function , and it did not depend on race or sex . Conclusions : Viral suppression was associated with GFR improvements in those with both low CD4 cell counts and impaired baseline renal function , supporting an independent contribution of HIV-1 replication to chronic renal dysfunction in advanced HIV disease . GFR improvement not associated with viral suppression also was observed in subjects with higher CD4 cell counts
Human immunodeficiency virus (HIV)-infected patients are at risk for renal disease as a consequence of complications of antiretroviral treatment .
Particularly , the complication of kidney disease is high in patients who switched to Tenofovir Disoproxil Fumarate .
The treatment is associated with nephrotoxicity , decrease in glomerular filtration rate , leading to kidney disease .
This review focused on assessing the effect of antiretroviral therapy ( ART ) on kidney function among HIV-positive patients .