
BIOCHEMICAL EVALUATION OF THE HEPATIC AND KIDNEY FUNCTIONS IN PATIENTS UNDERGOING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY AT THE BAFOUSSAM REGIONAL HOSPITAL, CAMEROON
Journal of International Research in Medical and Pharmaceutical Sciences,
Page 13-21
DOI:
10.56557/jirmeps/2022/v17i37994
Abstract
Background: Nowadays, one of the main ways to manage HIV infection is the use of highly active antiretroviral therapy (HAART). Despite the benefit associated with the use of antiretrovirals, these could have side effects on certain vital body functions such as the liver and kidneys.
Aim of the Study: The main objective of this study was to assess the liver and kidney functions of people living with HIV (PLWHIV) and undergoing highly active antiretroviral therapy at the Bafoussam Regional Hospital (BRH).
Methodology: A cross-sectional study was conducted for three months on 100 HIV-positive patients undergoing HAART at the Regional Hospital of Bafoussam. Sociodemographic, clinical and biological data were recorded for each subject and then analyzed using standard procedures. Liver function was explored by the following biochemical parameters: alanine aminotransferase, aspartate aminotransferase, albumin, total and direct bilirubin. The renal function was explored by measuring the creatinine and the serum uric acid levels. Results: Among the 100 patients who participated in the study, 83 were women (83 %) and 17 patients were men (17 %). The most represented age group was between 41 and 50 years old (37 %). The mean age was 47.66 ± 10.2 years. For the liver function assessment, 6 % had elevated alanine aminotransferase activity (greater than 42 IU/L), 8 % had an increase in the aspartate aminotransferase activity (greater than 38 IU/L) and 17% of patients had hypoalbuminemia (below 35 g/L). In addition, 14% of the patients had a high total bilirubin level (greater than 1 mg/dL) and 62% of the patients had a high direct bilirubin level (greater than 0.3 mg/dL). Patients presenting simultaneously an abnormal level of direct and total bilirubin were following the Zidovudine-Lamivudine-Atazan avir-Ritonavir (ZLAR) second line regimen. For the evaluation of renal function, 18% had a high creatinine level (greater than 14 mg/L) and 24% of patients had an abnormal level of uric acid (greater than 60 mg/L), this variation was not associated with antiretroviral treatment (p > 0.05).
Conclusion: No significant association was found between the regimen and the variations of certain biochemical parameters. However, compared to ZLAR, Tenofovir-Lamivudine-Dolutegravir (TLD) was the regimen that recorded the largest number of patients with abnormal variations of biochemical parameters involved in this study.
Keywords:
- Human immunodeficiency virus
- antiretrovirals
- transaminases
- bilirubin
- creatinine
- uric acid
How to Cite
References
Pang W, Shang P, Li Q, Xu J, Bi L, Zhong J et al. Prevalence of opportunistic infections and causes of death among hospitalized HIV-infected patients in Sichuan, China. Tohoku J Exp Med. 2018;244(3):231-42.
ONUSIDA. Country factsheetsCAMEROON 2019 [cited Jul 5 2021]. Available : https://www.unaids.org/sites/default/files/media_asset/testmtu_fr_0.pdf.
AIDS and hepatitis C professional group, Society of Infectious Diseases, Chinese Medical Association; Chinese Center for Disease Control and Prevention. 2021 ed. Infectious Diseases & Immunity. Chinese Guidelines for the Diagnosis and Treatment of HIV/AIDS. 2022;2(03):145-67.
Ellis R, Langford D, Masliah E. HIV and antiretroviral therapy in the brain: neuronal injury and repair. Nat Rev Neurosci. 2007;8(1):33-44.
Kotler DP. HIV and antiretroviral therapy: lipid abnormalities and associated cardiovascular risk in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;49;Suppl 2:S79-85.
Koethe JR, Lagathu C, Lake JE, Domingo P, Calmy A, Falutz J et al. HIV and antiretroviral therapy-related fat alterations. Nat Rev Dis Primers. 2020;6(1):48.
Khoza-Shangase K. Highly active antiretroviral therapy: does it Sound toxic? J Pharm Bioallied Sci. 2011;3(1):142-53.
Akksilp S, Karnkawinpong O, Wattanaamornkiat W, Viriyakitja D, Monkongdee P, Sitti W et al. Antiretroviral therapy during tuberculosis treatment and marked reduction in death rate of HIV-infected patients, Thailand1. Emerg Infect Dis. 2007;13(7):1001-7.
Murphy EL, Collier AC, Kalish LA, Assmann SF, Para MF, Flanigan TP et al. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern Med. 2001;135(1): 17-26.
Lawn SD, Harries AD, Wood R. Strategies to reduce early morbidity and mortality in adults receiving antiretroviral therapy in resource-limited settings. Curr Opin HIV AIDS. 2010;5(1):18-26.
World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach-2010 version. World Health Organization; 2010.
Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A et al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health. 2017;2(1):e35-46.
Kassanjee R, Johnson LF, Zaniewski E, Ballif M, Christ B, Yiannoutsos CT et al. Global HIV mortality trends among children on antiretroviral treatment corrected for under‐reported deaths: an updated analysis of the International Epidemiology Databases to Evaluate AIDS collaboration. J Int AIDS Soc. 2021;24(Suppl 5);Suppl 5:e25780.
Bozkurt B. Cardiovascular toxicity with highly active antiretroviral therapy: review of clinical studies. Cardiovasc Toxicol. 2004;4(3):243-60.
Khoza-Shangase K. Highly active antiretroviral therapy: does it Sound toxic? J Pharm Bioallied Sci. 2011;3(1):142-53.
Lohr JW, Willsky GR, Acara MA. Renal drug metabolism. Pharmacol Rev. 1998;50(1):107-41.
Almazroo OA, Miah MK, Venkataramanan R. Drug metabolism in the liver. Clin Liver Dis. 2017;21(1):1-20.
Coleman MD. Human drug metabolism. John Wiley & Sons; 2020.
Corsini A, Bortolini M. Drug‐induced liver injury: the role of drug metabolism and transport. J Clin Pharmacol. 2013;53(5):463-74.
Zakharia K, Tabibian A, Lindor KD, Tabibian JH. Complications, symptoms, quality of life and pregnancy in cholestatic liver disease. Liver Int. 2018;38(3):399-411.
Naschitz JE, Slobodin G, Lewis RJ, Zuckerman E, Yeshurun D. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J. 2000;140(1):111-20.
Lee WM. Drug-induced hepatotoxicity. N Engl J Med. 2003;349(5):474-85.
Gracen L, Hayward KL, Aikebuse M, Williams S, Russell A, O’Beirne J et al. An exploration of barriers and facilitators to implementing a nonalcoholic fatty liver disease pathway for people with type 2 diabetes in primary care. Diabet Med. 2022;39(6):e14799.
Yeung CK, Shen DD, Thummel KE, Himmelfarb J. Effects of chronic kidney disease and uremia on hepatic drug metabolism and transport. Kidney Int. 2014;85(3): 522-8.
Mocroft A, Kirk O, Reiss P, De Wit S, Sedlacek D, Beniowski M et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS. 2010;24(11):1667-78.
Hubert DJ, Meseka NM, Faustin AT, Florence NT, Maurice D. Body mass index and CD4 count in patients undergoing highly active antiretroviral treatment at the Bamenda Regional Hospital, Cameroon. JIRMEPS. 2022:1-10.
Hubert DJ, Kidia DS, Faustin AT, Rene WK, Florence NT. The prevalence of tuberculosis among BCG vaccinated individuals at the north west region of Cameroon. Asian J Med Health. 2022;20(11):1-11:Article no. AJMAH.90923 ISSN: 2456-8414.
Chakravarty J, Mehta H, Parekh A, Attili SVS, Agrawal NR, Singh SP et al. Study on clinico-epidemiological profile of HIV patients in eastern India. J Assoc Physicians India. 2006;54:854-7.
Kouanda S, Yaméogo WME, Berthé A, Bila B, Bocoum Yaya FK, Somda A et al. Self-disclosure of a HIV-positive serostatus: factors favoring disclosure and consequences for persons living with HIV/AIDS in Burkina Faso. Rev Epidemiol Sante Publique. 2012;60(3):221-8.
De Cock KM, Adjorlolo G, Ekpini E, Sibailly T, Kouadio J, Maran M et al. Epidemiology and transmission of HIV-2: why there is no HIV-2 pandemic. JAMA. 1993;270(17):2083-6.
Solomon S, Kumarasamy N, Ganesh AK, Amalraj RE. Prevalence and risk factors of HIV-1 and HIV-2 infection in urban and rural areas in Tamil Nadu, India. Int J STD AIDS. 1998;9(2):98-103.
Nyamweya S, Hegedus A, Jaye A, Rowland‐Jones S, Flanagan KL, Macallan DC. Comparing HIV-1 and HIV-2 infection: lessons for viral immunopathogenesis. Rev Med Virol. 2013;23(4):221-40.
Lyerly AD. Dolutegravir: advancing ethical research in pregnancy. Lancet. 2019;394(10213):1972-4.
Mayanja-Kizza H. Prevention of tuberculosis in HIV infection with novel drugs. Lancet HIV. 2020;7(6):e375-6.
Fokunang CN, Banin AN, Kouanfack C, Ngogang JY. Evaluation of hepatotoxicity and nephrotoxicity in HIV patients on highly active antiretroviral therapy. J AIDS HIV Res. 2010;2(3):046-57.
Stellbrink HJ, Reynes J, Lazzarin A, Voronin E, Pulido F, Felizarta F et al. Dolutegravir in antiretroviral-naive adults with HIV-1: 96-week results from a randomized dose-ranging study. AIDS (Lond Engl). 2013;27(11):1771-8.
Raffi F, Jaeger H, Quiros-Roldan E, Albrecht H, Belonosova E, Gatell JM et al. Once-daily dolutegravir versus twice-daily raltegravir in antiretroviral-naive adults with HIV-1 infection (SPRING-2 study): 96 week results from a randomised, double-blind, non-inferiority trial. Lancet Infect Dis. 2013;13(11):927-35.
Puoti M, Nasta P, Gatti F, Matti A, Prestini K, Biasi L et al. HIV-related liver disease: ARV drugs, coinfection, and other risk factors. J Int Assoc Physicians AIDS Care (Chic). 2009;8(1):30-42.
Suffrin JCD, Allan-Blitz LT, Taylor E, Ruderman T, Boti M, Moyo J. Presumed severe hepatocellular toxicity after initiation on a dolutegravir-based HIV treatment regimen in rural Malawi: A case report. Ann Clin Case Rep. 2022;7:2098.
Sudfeld CR, Isanaka S, Aboud S, Mugusi FM, Wang M, Chalamilla GE et al. Association of serum albumin concentration with mortality, morbidity, CD4 T-cell reconstitution among Tanzanians initiating antiretroviral therapy. J Infect Dis. 2013;207(9):1370-8.
Ezeugwunne IP, Ogbodo EC, Analike RA, Nnamdi JC, Iwuji JC, Obi-Ezeani CN et al. The pattern of alpha-fetoprotein, CD4+ count, albumin, AST, ALT and ALP in HIV subjects on long term antiretroviral therapy in Nauth Nnewi, Anambra State, Nigeria. Indian J Forensic Community Med. 2021;8(1):45-51.
Leal JA, Fausto MA, Carneiro M, Tubinambás U. Prevalence of hypoalbuminemia in outpatients with HIV/AIDS. Rev Soc Bras Med Trop. 2018;51(2):203-6.
Busti AJ, Hall RG, Margolis DM. Atazanavir for the treatment of human immunodeficiency virus infection. Pharmacotherapy. 2004;24(12):1732-47.
Panagopoulos P, Maltezos E, Hatzakis A, Paraskevis D. Hyperbilirubinemia in atazanavir treated HIV-infected patients: the impact of the UGT1A1* 28 allele. Pharmacogenomics Pers Med. 2017;10:205-8.
Aono T, Matsubayashi K, Kawamoto A, Kimura S, Ozawa T. Normal ranges of blood urea nitrogen and serum creatinine levels in the community-dwelling elderly subjects aged 70 years or over--correlation between age and renal function. [Nihon Ronen Igakkai zasshi]. Jpn J Geriatr. 1994;31(3):232-6.
Peters PJ, Moore DM, Mermin J, Brooks JT, Downing R, Were W et al. Antiretroviral therapy improves renal function among HIV-infected Ugandans. Kidney Int. 2008;74(7):925-9.
Pirro M, Bianconi V, Schiaroli E, Francisci D, Mannarino MR, Bagaglia F et al. Elevated serum uric acid levels are associated with endothelial dysfunction in HIV patients receiving highly-active antiretroviral therapy. Atherosclerosis. 2018;272:101-7.
Maggi P, Montinaro V, Bellacosa C, Pietanza S, Volpe A, Graziano G et al. Early markers of tubular dysfunction in antiretroviral-experienced HIV-infected patients treated with tenofovir versus abacavir. AIDS Patient Care STDs. 2012;26(1):5-11.
-
Abstract View: 184 times
PDF Download: 3 times