PREVALENCE, KNOWLEDGE AND ASSOCIATED RISK FACTORS OF CHRONIC KIDNEY DISEASE IN HIV-INFECTED ADULTS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPHY (HAART) IN OGUN-STATE. NIGERIA

OLADOJA FAROUK 163 PAGES (32847 WORDS) Thesis
Subscribe to access this work and thousands more

ABSTRACT

 Background: Chronic kidney disease (CKD) remains one of the complications of Human Immunodeficiency virus (HIV) infection among individuals on antiretroviral medication. This study aimed to determine the prevalence, Knowledge and associated risk factors of CKD among Ogun-state Indigenes with HIV on antiretroviral medications 

Materials and Methods: This was a hospital-based descriptive cross-sectional study involving 203 previously diagnosed HIV-infected patients on HAART treatment at the Institute of Human virology of Nigeria (IHVN) Clinic of the Olabisi Onabanjo University Teaching Hospital (OOUTH)

A semi-structured instrument (questionnaire) was used for data collection. The instrument had various sections based on the conceptual framework used for the study. 

The participants aged between 18 and 70 years were conveniently and purposively recruited into the study. Using patients’ folders, data on patients’ age, gender, type of medication(s) and duration on HAART medication were obtained. Patients’ blood samples were obtained for the estimation of serum creatinine concentration. Estimated Glomerular Filtration Rate (eGFR) was calculated based on serum creatinine levels using the four-Variable Modification of Diet in Renal Disease (4v-MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.  

The prevalence, knowledge, and associated risk factors of CKD in HIV adults on HAART was deciphered. Data collected were analyzed using Statistical Package for Social Science (SPSS) with levels of significance set at 0.05

Descriptive statistics of variables were reported as either frequencies (percentages), or mean (standard deviation). Chi-square was used to test for demographic characteristics, risk factors of CKD in HIV- Positive adults, binary and multiple regression analysis to test independent factors associated with CKD

CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min and/or proteinuria ≥1+ according to standard guidelines. 

Results: Proteinuria was found in 22 (10.8%) of the HIV group, with reduced eGFR found in 19 (9.3%) of the HIV group using both the 4v-MDRD and CKD-EPI equations. CKD (eGFR <60 ml/min/+proteinuria) was found in 28(13.8%) of the HIV group. Using the 4v-MDRD equation, the prevalence of CKD was higher among the female participants 17(16.8%), compared to their male counterparts 2 (22.0%).  The most common ART regimen among the study participants, 114(56.2%) were on TDF/3TC/EFV, in the same vein was the most prominent cocktail associated with CKD

Results also showed that female sex, hypertension, diabetes, and proteinuria in the HIV population were closely associated with CKD. 

The study also showed a poor knowledge outcome amongst the study participant

Conclusion: The burden of renal disease in HIV‑infected patients is high. Early diagnosis and treatment of HIV may reduce the tide. HAART regimen containing concurrent Tenofovir had the highest CKD among the participants

Keywords: chronic kidney disease, estimated glomerular filtration rate, HIV, proteinuria



TABLE OF CONTENTS

PAGE

Title page                                                                                                                                    i

Dissertation                 ii

Certification                                                                                                                                iii

Dedication     iv

Acknowledgements                  v

Abstract                vi

Table of content    vii

List of tables                                                                                                                              xii

      

List of figures                                                                                                                            xv

Abbreviations               xvi





TABLE OF CONTENT

CHAPTER ONE: INTRODUCTION                                                                    PAGE

1.1 Background to the Study                                                                                              1

    1.2 Statement of the Problem                                                                                             2

1.3 Justification of the Study                                                                                              3

    1.4      Aims and Objectives of the Study                                                                                4

    1.5      Research Question                                                                                                        5

 REVIEW OF LITERATURE

Overview of HIV-related chronic kidney disease in the era of Highly Active Anti-retroviral Therapy (HAART)                                                                                                                      6

Pathogenesis of HIVAN and Other HIV-Related Kidney Diseases                                            7

Defining HIV-Related Kidney Disease in Different Populations                                                8

The Changing Epidemiology of HIV-Related Kidney Disease in Resource-Rich Setting          9

The Spectrum of HIV-Related Kidney Disease in Sub-Saharan Africa                                       9

Risk Factors for the Development of Chronic Kidney Disease with HIV/AIDS                        12

Risk Factors for Renal Disease in HIV                                        13

Prevalence of Chronic Kidney Disease in HIV Infection                                                            14

HIV-Associated Chronic Kidney Disease in Sub-Saharan Africa      15

Role of Genetics in HIV Chronic Kidney Disease                                                                       18  

Histo-Pathological Correlations in HIV-Associated Chronic Kidney Disease                          18

Chronic Kidney Disease                                                                                                             19                   

Chronic Kidney Disease–Associated Anemia                                                                            40

CKD-Associated Mineral and Bone Disorders                                                                           42 

Cardiovascular risk                                                                                                                     45

Dyslipidemia                                                                                                                               49

Nutritional Issues      54


     

Epidemiology of HIV in Sub-Saharan Africa                                                                             56



Epidemiology of HIV in Nigeria        58

Virology: Classification and Structure        62

HIV Transmission                    64

Natural History of HIV         67

The WHO Clinical Staging System         68

Goals of Antiretroviral Therapy                      69

ART Regimen              69



CHAPTER TWO: METHODOLOGY

Patients and Methods     72

Study Setting     72

Study Design     72

Sample Size     72

Sample Size Determination     73

Inclusion Criteria     74

Exclusion Criteria     74

Informed Consent     74

Participant Recruitment Procedure     75

Definitions of Terms     76

Data Handling     76

Statistical Analysis     77

Ethical Consideration     77

CHAPTER THREE: DATA ANALYSIS AND RESULTS

                                                                                               

RESULTS 78

CHAPTER FOUR

DISCUSSION 121

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATION                                                                             

CONCLUSION                 129

LIMITATION OF THE STUDY                                                                                        130

RECOMMENDATIONSm111111124hh1611 444445                                                            111h

IMPLICATION OF THE STUDY TO HEALTH PROMOTION AND EDUCATION

REFERENCES
















LIST OF TABLES

       Table               Page Table 1:   2014 HIV/AIDS statistics (Nigeria, Sub-saharan Africa)                                            60

Table 2:   Distribution of socio demographic profile of respondents                                           79

Table 3:   Co-morbidities and treatment of the respondents                                                         81

Table 4:   Co-morbidities of respondents stratified by viral load                                                 83

Table 5: Other treatments of the respondents stratified by viral load                                            85

Table 6: Kidney disease features stratified by viral load                                                              87

Table 7:  HAART regimen taken by respondent                                                                          89

Table 8: HAART Regimen in relation to Gender                                                                         94

Table 9: Demographic characteristics of respondents stratified by Tenofovir and non Tenofovir based regimen                                                                                                                               96

Table 10: Clinical characteristics of respondents stratified by Tenofovir and non Tenofovir based regimen                                                                                                                                         98

Table 11: Kidney function parameters stratified by Tenofovir and non Tenofovir regimen       101                                                                                                                                    

Table 12 Participants Knowledge of Chronic Kidney Disease in HIV by gender                      104


Table 13: Chronic kidney diseases staged with 4V-MDRD and CKD-EPI equations                109

Table 14: Chronic kidney diseases staged with 4V-MDRD and CKD-EPI equations 

Stratified by gender                                                                                                                      110

Table 15: Chronic kidney diseases staged with 4V-MDRD and CKD-EPI equations 

Stratified by gender with P-values                                                                                                 111

Table 16 Proteinuria analysis of respondents by Protein dipstick grading                                  112

Table 17: Chronic kidney disease stratified by CD4 status, regimen type, component drug and age among HIV-infected patients                                                                                                113

Table 18: Associated risk and drug factors of chronic kidney disease in HIV-infected adults on HAART                                                                                                                                      


  LIST OF FIGURES

    Figure                       Page 

1: Interplay of processes secondary to chronic kidney disease leading to cardiovascular disease and death. Red arrows: Pathogenetic pathways; black arrow: feedback loop                        53           

     2: Distribution of respondents’ history of HIV disease and Antiretroviral Therapy             91

     3: Distribution of respondents’ history of HIV disease and Antiretroviral Therapy              93

     4: Bar chart of CKD staged with 4V-MDRD and CKD-EPI equations                                109

     5: Bar chart showing relationship between BMI range and Diabetes                          117

     6: Bar chart showing relationship between BMI range and Hypertension                118

     7: Bar chart showing relationship between BMI range and Heart failure                 119

     8: Bar chart showing relationship between BMI range and Sickle cell                    120


     

      

  

Subscribe to access this work and thousands more
Overall Rating

0

5 Star
(0)
4 Star
(0)
3 Star
(0)
2 Star
(0)
1 Star
(0)
APA

OLADOJA, F (2019). PREVALENCE, KNOWLEDGE AND ASSOCIATED RISK FACTORS OF CHRONIC KIDNEY DISEASE IN HIV-INFECTED ADULTS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPHY (HAART) IN OGUN-STATE. NIGERIA. Afribary.com: Retrieved August 25, 2019, from https://afribary.com/works/prevalence-knowledge-and-associated-risk-factors-of-chronic-kidney-disease-in-hiv-infected-adults-on-highly-active-anti-retroviral-theraphy-haart-in-ogun-state-nigeria

MLA 8th

FAROUK, OLADOJA. "PREVALENCE, KNOWLEDGE AND ASSOCIATED RISK FACTORS OF CHRONIC KIDNEY DISEASE IN HIV-INFECTED ADULTS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPHY (HAART) IN OGUN-STATE. NIGERIA" Afribary.com. Afribary.com, 23 Jul. 2019, https://afribary.com/works/prevalence-knowledge-and-associated-risk-factors-of-chronic-kidney-disease-in-hiv-infected-adults-on-highly-active-anti-retroviral-theraphy-haart-in-ogun-state-nigeria . Accessed 25 Aug. 2019.

MLA7

FAROUK, OLADOJA. "PREVALENCE, KNOWLEDGE AND ASSOCIATED RISK FACTORS OF CHRONIC KIDNEY DISEASE IN HIV-INFECTED ADULTS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPHY (HAART) IN OGUN-STATE. NIGERIA". Afribary.com, Afribary.com, 23 Jul. 2019. Web. 25 Aug. 2019. < https://afribary.com/works/prevalence-knowledge-and-associated-risk-factors-of-chronic-kidney-disease-in-hiv-infected-adults-on-highly-active-anti-retroviral-theraphy-haart-in-ogun-state-nigeria >.

Chicago

FAROUK, OLADOJA. "PREVALENCE, KNOWLEDGE AND ASSOCIATED RISK FACTORS OF CHRONIC KIDNEY DISEASE IN HIV-INFECTED ADULTS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPHY (HAART) IN OGUN-STATE. NIGERIA" Afribary.com (2019). Accessed August 25, 2019. https://afribary.com/works/prevalence-knowledge-and-associated-risk-factors-of-chronic-kidney-disease-in-hiv-infected-adults-on-highly-active-anti-retroviral-theraphy-haart-in-ogun-state-nigeria