Abstract
Background: Human immunodeficiency virus (HIV)
infection is a global health problem with increased
burden on medical facilities worldwide. HIV/AIDS
is associated with many complications especially
when there is delayed diagnosis, late commencement
of management and toxicity from antiretroviral
therapy (ART). The onset of chronic kidney disease
usually manifests with mild reduction in glomerular
filtration rate. This study was designed to compare
the nephrotoxic effect of Tenofovir, Lamivudine,
Efavirez (DCA) and Zidovudine, Lamivudine,
Nevirapine (DCB) combinations used in
management of HIV Patients.
Methods: We measured serum creatinine and cystatin
c levels in 55 HIV patients on three years ART and
calculated glomerular filtration rates derived from
serum creatinine and cystatin-c using Chronic
Kidney Disease Epidemiology Collaboration
equations.
Results: The mean serum creatinine (89.89
±16.99µmol/L) and cystatin-c (1.02±0.10mg/L)
values for HIV patients on DCA were significantly
higher when compared with corresponding values
in HIVpatients on DCB (79.00±10.39 µmol/L and
0.91±0.12 mg/L) respectively. Also the mean
GFRcreat values (97.25±20.15) and GFRcyst values
(80.71±9.96 ml/min/1.73m2 ) of HIV patients on DCA
were significantly lower when compared with
corresponding values in HIV patients on DCB
(115.85±12.82 ml/min/1.73m2 and 93.78 ±15.30ml/
min/1.73m2 ) respectively. Conclusion: We concluded
that the use of Zidovudine, Lamivudine, Nevirapine
drug combination appears safer than Tenofovir,
Lamivudine, Efavirenz combination.
References
Elflain, J. Top ten causes of deaths in low–income
countries 2016. (internet) 2020. Cited 2021
August, 7) Available from: https://
www.statista.com/statistics/311934/top – ten –
causes – of – death in – low – income – countries.
World Health Organization. Leading causes of
death by income group (internet) 2020. Accessed
th August, 2021. Available from: who.int/news
– room/food-starts/detail/the top – 10 –causes –
of – death.
Bove, A., Bishikwabo-Nsarhaza, K., Muangadura,
G. The spread and effect of HIV-1 infection in Subsaharan Africa. Lancet 2002 359: 2011-2017
Olaleye R.S. Level of HIV/AIDS Awareness
among rural famers and its implication for food
security in Ondo State, Nigeria. Agric Sec Res
3(2): 1-11
Marks G., Crepaz N and Janssen R.S. Estimating
sexual transmission of HIV from persons aware
and unaware that they are infected with the virus
in the USA. AIDS 2006 20: 1447-1450.
Wingfield, T and Ed, W. Opportunistic infections
in HIV disease. British Journal of Nursing 2010
(10): 621-627
Lyons J., Venna N and Cho T.A. Atypical nervous
system manifestations in HIV. Semin Neurol
31: 254-265
Palella, F.J., Delaney, K.M., Moorman, A.C.,
Loveless ,M.O., Fulire, J., Satten, G.A. Declining
morbidity and advanced human
immunodeficiency virus infection. N Eng J. med
338: 853-860
Hogg R.S., YIP B., Kully C., Craib K.J.P.
O’Shaughnessy M.V. and Schechter, M.T.
Improved survival among HIV-1 infected
patients after initiation of triple-drug
antiretroviral regimen. CMAJ 1999 160(5): 73-
Fernadez – Montero, J.V., Eugenia, E., Barreiro
P., Labarga P. and Spriano V. Antiretroviral
drugs–related toxicities–clinical spectrum,
prevention and management. Exp Opin on Drug
Saf 2013 12(5):697 – 707.
Valentina M., Natasha P., Marianne H., Linda
A., Julio S.G.M. Adverse effect of antiretroviral
therapy for HIV infection. CMAJ 2004 170(2):
-238
Vaidya K.A., Kadam A.V and Nema V.
Antiretroviral drugs for HIV: Old and New. J
HIV/AIDS Res 2016 3(2): 1026.
Fukunang C.N., Banin A.N., Kouanface C. and
Ngogang J.Y. Evaluation of hepatotoxicity and
nephrotoxicity in HIV patients on highly active
antiretroviral therapy. J AIDS HIV Res 2010 2:
-57
Waheed, S and Atta, M.G. Predictors of HIV
associated nephropathy. Expert Rev Anti infect
ther 2014 12: 555-563
National Action Committee for the Control of
AIDS. Global AIDS response: Country progress
report 2014. Accessed October 2, 2016. https://
naca.gov.ng/wp-content/uploads/2016/11/
Nigeria-GARPR-2014.pdf Pp 22
Sin–Ho and Jung. Stratified Fisher’s exact test
and its sample size calculation Biometric J 2014.
(1):129 – 40.
Lesley A.I., Christopher H.S., Hocine T., et al.
Estimating glomerular filtration rate from serum
creatinine and cystatin C. N Engl J med 2012
:20-29
Boden D., Hurley A., Zhang L., et al., HIV–1
drug resistance in newly infected individuals.
JAMA 1999. 282(12):1135-1141.
Havlir D.V., Eastman S., Gamst A and Richman
D.D. Nevirapine–resistant human
immunodeficiency virus. J Virol 1996 70:7894
– 7899.
Pevelson A., essunger P., Cao Y., et al. Decay
characteristics of HIV-1 infected components
during combination therapy. Nature 1997.
:188–199.
Kahlert C.R., Cyprian M and Vernazza P. Novel
dual HIV maintenance therapy with Nevirapine
plus Lamivudine retain viral suppression through
CC Nganwuchi, AJ Onuegbu, MI Olisekodiaka, et al.
weeks — A proof-of-concept study. PLOS
ONE 2020 15(9):e0237770. Available from:
https://doi.org/10.1371/journal.pone.0237770
Miguel G, Shanshan L, Brookie B, et al. L.
Greater Tenofovir Associated Renal Function
Decline with protease Inhibitor-Based Versus
Non-nucleoside Reverse Transcriptase InhibitorBased therapy. J Infect Dis 2008 197(1): 102-
Clive P., Michael J., Michael A. and Brian B.
Integrated Pharmacology. 3rd Edition, Mosby
Ltd, London 2006. Pp 102-104
John R.G Jr and Micheal E.B. Zidovudine in
Renal failure. Seminars in Dialysis 1999 3(2):
-104.
DrugBank. Efavirenz (internet). Cited 2021
August 13. Available from: https://
www.drugbank.ca/drugs/DB00625
Gitman M.D., Hirschwerkd D., Baskin C.H. and
Singhad P.C. Tenofovir-induced kidney injury.
Exp opin Drug Saf 2007 6(2):155-164
Ceckova M, Reznicek J, Deutcsh M and Staud
F. Efavirenz reduces renal excretion of
Lamivudinein rats by inhibiting organic cation
transporter (OCT) and multidrug and toxin
extrusion proteins (MATE). P LOS ONE 2018
(8): eo202706