The emergence of highly active antiretroviral therapy (HAART) has led to dramatic
improvements in prolonging survival of HIV-infected patients on treatment in
resource-limited areas. However, the main drawback of HAART that long-term use
has the potential to cause liver and kidney derangements that may be life-threatening.
These important complications sometimes warrant switch or discontinuation of
antiretroviral therapy. Information on the prevalence of the above complications in
Kenya is scanty. The current study assessed the prevalence of hepatic and renal
toxicity in one hundred and fifty HIV+ patients [50 HAART naïve and 100 HAART
treated subjects] based on clinical laboratory assays. Data were matched for HAART
status, age, sex and the duration the patients had been on ARV treatment. The data
was analyzed using SAS version 9.2. The prevalence of hepatotoxicity based on
elevated alanine aminotransferase analyte above upper limit of normal was 18% in
HAART treated and 8% in HAART naïve patients. The prevalence of renal
derangements based on elevated creatinine analyte above upper limit of normal was
4% in HAART treated and 8% HAART naïve group. However, the prevalence of
hepatotoxicity and renal derangements cases did not vary significantly between
HAART treated and HAART naïve subjects (χ2
; P =0.59 and P = 0.9 respectively).
Variation in liver and kidney analytes were compared between gender using student’s
t-test and variation in data for liver and kidney analytes were compared for age and
duration the patients were on HAART using ANOVA with statistical significance set
at α=0.05. The key liver and kidney analytes indicative of hepatotoxicity and renal
insufficiency varied significantly between males and females; (ALT; P=0.001) and
(CREAT; P=0.001) respectively. Liver and kidney analytes varied significantly with
age; (ALT; P=0.006) and (CREAT: P=0.001) respectively and the duration the
patients had been on HAART; (ALT; P=0.002) and (CREAT; P=0.001) respectively.
In conclusion, prevalence of hepatotoxicity was 17.3% and renal insufficiency was
5.3% in all HIV positive subjects irrespective of HAART status. The prevalence of
hepatotoxicity was higher in the HAART treated, female gender, patients aged above
46 years or have been on HAART for more than 4 years. Renal insufficiency was
more common in HAART naïve patients, female gender, and patients aged more than
46 years. Results from this study will help healthcare actors and providers to pay
greater attention to individualized treatment of HIV and AIDS using HAART so as to
reduce toxicities and co-morbidities that reduce the quality of life and increases the
risk of death. They can also help in harmonizing HAART regimens and prescription
dosage in order to reduce toxicity levels. The study recommends a controlled research
study to be carried out to tease out toxic individual drug agents within HAART
classes on liver and kidney functions.