Effect of Antiretrovirals on Renal Function of HIV/AIDS Patients at Two Hospitals in Yaounde, Cameroon

Abstract

Background: Antiretroviral therapies (ART) have been reported to have renal toxicity. However, there is a lack of data on the toxicity of ART in sub-Saharan countries, especially in Cameroon. More studies on their contribution to renal dysfunction in natives from this region are required.Methods: HIV/AIDS patients undergoing eleven different first-line ART at two hospitals in Yaoundé, Cameroon, were selected in this study. Retrospective and prospective data of serum urea and creatinine were collected, and the estimated Glomerular Filtration Rate (eGFR) was calculated. Wilcoxon signed-rank test, paired t-test and chi-square test were used for statistical analysis. The level of significance was set at p < 0.05.Results: Out of 187 participants, there were 134 women (71.66%). The age ranged from 24 to 77 years, with a mean age of 42.47 ± 10.68. The mean serum urea level increased after ART initiation for D4T40 + 3TC + NVP (p = 0.011) and TNF + 3TC + EFV + INH (p = 0.03) regimen in women and for TNF + 3TC + EFV + CTM (p = 0.03) in men. It decreased for D4T40 + 3TC + NVP (p = 0.03) in men. The mean serum creatinine increased for women following regimen AZT + TNF + NVP (p = 0.022) and D4T40 + 3TC + NVP (p = 0.028), and for men on AZT + TNF + NVP (p = 0.03). There was rather a decrease in blood creatinine for women on AZT + 3TC + NVP regimen (p = 0.0032). Mean eGFR decreased for patients on AZT + TNF + NVP (p = 0.015), D4T40 + 3TC + NVP (p = 0.016) and TNF + 3TC + EFV + INH (p = 0.03) regimen. The eGFR dropped below the threshold of 60 ml/ min/1.73 m 2 , for 5/12 patients on D4T40 + 3TC + NVP, 2/6 patients on TNF + 3TC + EFV + INH, 1/4 patients on TNF + 3TC, 6/74 patients on TNF + 3TC + EFV and 1/28 patients on TNF + 3TC + EFV + CTM regimen. However, a significant increase of the eGFR has been observed for treatments with AZT + 3TC + NVP (p = 0.0001), 3TC + TNF + EMB (p = 0.032) and D4T30 + 3TC + EFV (p = 0.032) regimen. Conclusion:Antiviral therapy with stavudine 40 mg (D4T40) or tenofovir-based regimen could lead to renal toxicity. However, the results show that D4T30 + 3TC + EFV, 3TC + TNF + EMB or AZT + 3TC + NVP combinations would be rather protective for renal function, andshould be recommended.