Abstract

*Dr. Sushma S. Gaikwad, Dr. Dileep Asgoankar and Dr. Astha Ganeriwal

ABSTRACT

Introduction: Chronic kidney disease (CKD) appears to be a common complication of HIV infection in the modern era of ART. The prevalence of CKD ranges from 3.5% to 32.6%, depending on the characteristics of the study population and the criteria used to define CKD. Hence study was conducted to estimate the creatinine clearance and eGFR in HIV positive patients and its correlation with ART regimen and CD4 count. Methods: This prospective cross-sectional observational study was carried out in the BYL Nair Hospital, Mumbai during the period of July 2013 to December 2014 for a period of 18 months. Total 150 adult patients (age >18 years) were enrolled. Their demographic profile, clinical data along with routine blood and urine investigations, CD4 count and treatment including ART regimen namely TDF (Tenofovir based) and AZT (Zidovudine based) were recorded. Findings were tabulated and compared and result were analysed using SPSS 17. Results: In our study, out of the total 150 patients, 92(65.33%) were males and 58(34.6%) females with a mean age of 34.6 years. Total 79 (52.6%) patients were on TDF based ART regimen, 60 (39.47%) were on AZT based ART regimen and 11(7.3%) were not on ART. The mean creatinine clearance was 46.33 ml/min in patients with CD4 count < 200, it was 65.94 ml/min in patients with CD4 200-350 and 81.41ml/min in patients with CD4>350, which was statistically significant (p<0.05). Also the mean values of eGFR in patients with CD4 < 200 was 61.75 ml/min/1.73 m 2 , in those with CD4 200 - 350 was 83.56 ml/min/1.73 m2 and 103.47 ml/min/1.73 m 2 in those with CD4> 350. And this is statistically significant (p<0.05) There is an inverse correlation of CD4 cell count and eGFR and creatinine clearance. The mean creatinine clearance in the TDF group was 61.59 and in the other group it was 83.75 which was statistically significant (p<0.05); the mean eGFR in TDF group was 78.47 and in the other group it was 103.46 which was statistically significant (p<0.05). There was a significant association between low eGFR and creatinine clearance and TDF based ART regimen. Conclusion: Decline in eGFR values and creatinine clearance is more common in patients treated with TDF based ART regimen and with advanced stages of HIV infection.