Effects of highly active antiretroviral treatment on liver and renal functions of HIV-infected patients attending the day care clinic of the Bamenda Regional Hospital, Cameroon

Abstract

Background: Though the development of antiretroviral therapy has brought some relief to the menace of HIV infections, the side effects and toxicity of these drugs can still present a major challenge to users, thus leading to a switch or discontinuation of treatment. The aim of this study was to determine the effect of antiretroviral treatment on some biochemical markers of liver and renal functions among HIV-infected patients receiving treatment at the Day Care Clinic of the Regional Hospital, Bamenda, Cameroon.
Methodology: A case control study design comprising 100 HIV-infected patients on highly active antiretroviral therapy (HAART) and 100 HIV-negative controls was conducted from February to May 2019. The serum activity of aspartate amino transferase (AST) and alanine amino transferase (ALT), and serum creatinine levels for each group were measured using BIOSMART 240 autoanalyzer. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault formula while proteinuria was determined with the CYBOW 11M strips. Data were analyzed using IBM SPSS version 21.0. Differences in the serum activity and levels of the biomarkers between the case and control groups were analyzed using the Chi-square test.
Results: The prevalence of transaminitis (AST and ALT >40.0 U/L) among HAART-treated participants was 26.0% for AST and 20% for ALT while that of HIV-negative controls were 15% and 12% respectively but the difference was not statistically significant (p>0.05). Elevated serum creatinine level (>1.4 mg/dL) was seen in 25% of HAART-treated group compared to 7% in HIV-negative control (p=0.0010) while renal impairment (eGFR<60 ml/min/1.73m2) was seen in 24% of HAART-treated and 14% of HIV-negative group (p=0.1048). Elevated activity of transaminases and levels of creatinine, proteinuria and abnormal eGFR in HAART-treated patients were mostly seen in those who were on first line antiretroviral therapy, and those who have been on treatment for over 5 years.
Conclusion: HAART is associated with transaminitis and elevated serum creatinine but no increase in renal impairment compared to the general population. It is important that following initiation of HAART, liver and kidney functions are regularly monitored.

Keywords: HIV; HAART; AST; ALT; eGFR