Oxidative Stress, Renal Dysfunction and Haematological Profile among Haart Naïve HIV Infected Ghanaian Patients and Those on HAART
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June, 2010
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Abstract
In a cross-sectional study to assess oxidative stress, renal dysfunction and haematological complications among Ghanaian HIV infected patients, 442 people living with HIV/AIDS (PLWHA) consisting of 166 patients on highly active antiretroviral therapy (HAART) and 276 HAART naïve patients from the antiretroviral (ART) clinic at the Regional Hospital, Bolgatanga were recruited for this study. Complete haemogram, immunological analysis (CD4 & CD3), biochemical analysis and weight were measured for all the patients. Females outnumbered males by 3 to 1 in the HAART naïve group and 5 to 1 in subjects on HAART. Patients on HAART were older and heavier than their naive counterparts and were on a backbone therapy of nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs): 41.6% were on a combination therapy of (Combivir + Efavirenz); 41.0% (Combivir + Nevirapine); 10.8% (Stavudine + Lamivudine + Nevirapine) and 6.6% (Stavudine + Lamivudine + Efavirenz). The incidence of anaemia (Hb ≤ 10.5 = 63.0%) and lymphopoenia (16.7%) in HAART naive patients was significantly higher compared to their counterparts on HAART (46.0% and 5.3% respectively). The incidence of anaemia in HAART naïve females was 70% compared to 44% in HAART naive males (P = 0.0001). HAART naïve patients are 5 times at risk of developing microcytic hypochromic anaemia compared to those on HAART (P = 0.0002). Total lymphocyte count (TLC), haemoglobin, lymphocyte count and weight were significant predictors of CD4 counts and TLC values between 1.0 – 2.0 k µL-1 was a significant predictor of CD4 counts < 200 cells mm-3. Vitamin C was reduced across the general study population but significantly reduced in patients on HAART in comparison to the HAART naïve group (P < 0.0001). MDA was elevated by about 10-fold across the study group. The incidence of isolated hypercholesterolaemia in HAART naïve patients and patients on HAART is 2.2% and 18.1% respectively; isolated hypertriglyceridaemia (16.3% vs. 31.9%); isolated decreased HDL-C (35.9% vs. 38.6%) and isolated increased LDL-C (1.5% vs. 3.6%). The overall incidence of hypocalcaemia was 14.1% and 41.6% in HAART naïve patients and patients on HAART respectively. The incidence of chronic kidney disease (CKD) in the study population calculated with the Cockcroft-Gault, 4v-MDRD and CKD-EPI equations was 10.9%, 10.4% and 10.7% respectively. A comparison of methods saw the CKD-EPI equation yielding lower bias to the Cockcroft-Gault and 4v-MDRD equations. HAART has the capability of reducing the incidence of anaemia and lymphopoenia which are associated with disease progression and death in HIV infected patients. Total lymphocyte count, lymphocyte count, haemoglobin and weight could also serve as useful predictive tools in the management and monitoring of HIV infected patients in resource limited settings. CKD is not uncommon among HIV infected Ghanaian patients and a significant proportion (≈10%) will require antiretroviral dose adjustment either at the time of initiating therapy or sometime during on-going therapy.
Description
A thesis submitted in fulfillment of the requirements for the degree of Master of Philosophy in the Department of Molecular Medicine, School of Medical Sciences.