• Emmanuel Ikechukwu Onwubuya Department of Internal Medicine, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, P.M. B 5025, Anambra State, Nigeria
  • Nkiruka Rose Ukibe Deparment of Medical Laboratory Science, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, P. M. B 5025, Anambra State, Nigeria
  • Ofia Anya Kalu Department of Internal Medicine, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, P.M. B 5025, Anambra State, Nigeria
  • Solomon Nwabueze Ukibe Department of Prosthesis and Orthotics, Federal University of Technology, Owerri, Imo State, Nigeria
  • Imo John Obasi Deparment of Medical Laboratory Science, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, P. M. B 5025, Anambra State, Nigeria


Objective: Antiretroviral therapy (ART) is anticipated to result in an increase in long-term survival in human immunodeficiency virus (HIV) infected individuals, but may present with the development of associated complications including kidney damage. The present study aimed at assessing the kidney function estimated glomerular filtration (eGFR) rate and body mass index (BMI) of HIV seropositive subjects with or without HAART at Nnewi, Nigeria.

Methods: A total of 90 subjects were recruited comprising of 30 HIV-seropositive on highly antiretroviral therapy (HAART), 30 HIV-seropositive drug naive, and 30 HIV-seronegative (control subjects). Anthropometric parameters of the subjects were assessed using a well-structured questionnaire. Five millilitres of blood sample was collected from the patients and used for the estimation of urea, creatinine, uric acid, serum total protein and cluster of differentiation (CD4) T-cell counts using diacetyl monoxime method, Jaffe-slot method, Caraway phosphotungstic acid method, refractometry and flow cytometric method respectively.

Results: The result shows significantly higher mean serum urea, creatinine and uric acid levels in HIV seropositive drug-naive subjects and HIV seropositive subjects on HAART when compared with control (p<0.05). Similar observation were made with same parameters between HIV seropositive drug-naive subjects and HIV subjects on HAART (p<0.05). However, total protein and CD4 T-cells counts were significantly lower in HIV seropositive drug-naive subjects compared with HIV subjects on HAART and controls (p<0.05). Based on the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, 6 (20.0%) of HIV seropositive subjects on antiretroviral therapy had a mild renal impairment, while 2 (6.6%) had a moderate renal impairment. Based on the modification of diet in renal disease (MDRD) equation, 7 (23.3%) of HIV subjects on therapy had mild renal impairment while 2 (6.6%) had a moderate renal impairment. Among the HIV drug naïve subjects, 8(26.7%) had mild renal impairment based on both equations. However, there were no significant differences in BMI and eGFR between HIV seropositive subjects on therapy and HIV seropositive drug-naive subjects.

Conclusion: The present study shows evidence of significant alterations in serum urea, creatinine, and uric acid levels with mild and moderate state of renal impairment in HIV infected subjects with or without therapy. The significantly lower CD4 count and serum total protein in HIV naive subjects compared with HIV on HAART and control indicates reduced cellular immunity. Routine kidney function test using longitudinal study and more sensitive predictors for renal damage are recommended to ascertain the clearer picture of renal disease burden among HIV subjects in this environment.

Keywords: Renal function, Estimated glomerular filtration rate, Body mass index, HIV HAART


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1. Arindam P, Maitreyee B, Shantasil P, Biswadip G, Sandip S, Anirban G. Anaemia in antiretroviral naive HIV/AIDS patients: a study from Eastern India. J Health Allied Sci 2011;10:973-97.
2. World Health Organization. Global Human Immunodeficiency Virus Report; 2015. Available from: [Last accessed on 10 Feb 2017]
3. The Joint United Nations Programme on HIV/AIDS. HIV and AIDS Estimates; 2015. Available from: regionscountries/countries/nigeria.pdf. [Last accessed on 08 Feb 2017]
4. Guyton AC, Hall JE. Textbook of medical physiology. 12th ed. Philadelphia: Elsevier; 2011. p. 303-5.
5. Waad AS, Mula-Abed KR, Dawood AR. Estimated glomerular filtration rate (eGFR): a serum creatinine-based test for the detection of chronic kidney disease and its impact on clinical practice. Oman Med J 2012;27:108–13.
6. Irfanullah K, Amer HK, Azreen SA, Amjad K. Serum cystatin c role in the identification of renal dysfunction among elderly CKD patients. Asian J Pharm Clin Res 2016;9:2.
7. Aria AR. Chronic Kidney Disease. JAMA 2016;315:2248.
8. Röling J, Schmid H, Fischereder M, Draenert R, Goebel FD. HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy. Clin Infect Dis 2006;42:1488-95.
9. Ustianowski A, Arends JE. Tenofovir: what we have learnt after 7.5 million person-years of use. Infect Dis Ther 2015;4:145–57.
10. Antoniou T, Raboud J, Chirhin S, Yoong D, Govan V, Gough K, et al. Incidence of and risk factors for tenofovir-induced nephrotoxicity: a retrospective cohort study. HIV Med 2005;6:284–90.
11. Walker UA, Hoffmann C, Enters M, Thoden J, Behrens G, Mitzel SL. High serum urate in HIV-infected persons: the choice of the antiretroviral drug matters AIDS 2006;20:1556-8.
12. Bochet MV, Jacquiaud C, Valantin MA, Katlama C, Deray G. Renal insufficiency induced by ritonavir in HIV-infected patients. Am J Med 1998;105:457.
13. Gadzik J. How much should I weigh?"--Quetelet's equation, upper weight limits, and BMI prime. Conn Med 2006;70:81-8.
14. World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. J Am Med Assoc 2018;310:2191-4.
15. World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach; 2010. p. 19–20. Available from: [Last accessed on 28 Jun 2017]
16. Frylanda M, Chaillet P, Zachariahc R, Barnaba A, Bontee L, Andereassena R, et al. The partec CyFlow Counter® could provide an option for CD4+T-cell monitoring in the context of scaling-up antiretroviral treatment at the district level in Malawi. Transact Royal Soc Trop Med Hyg 2006;100:980-5.
17. Kaplan A, Teng LL. Urea in serum, urease-bertholet method. Sel Methods Clin Chem 1982;9:357.
18. Ingebretsen OC, Borgen J, Farstad M. Uric acid determinations: reversed-phase liquid chromatography. Diabet Care 2005;28:164-76.
19. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Int Med 1999;130:461–70.
20. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) 2009;151:892-3.
21. Onodugo OD, Chukwuka C, Onyedum C, Ejim E, Mbah A. Baseline renal function among antiretroviral therapy-naive, HIV-infected patients in South East Nigeria. J Int Assoc Providers AIDS Care 2013;13:746–80.
22. Eneyew K, Seifu D, Menon M. Assessment of renal function among HIV-infected patients on combination antiretroviral therapy at tikur anbessa specialized hospital, addis ababa, ethiopia. Tech Invest 2016;7:107-22.
23. Reddy A, Prasad R. Renal function in antiretroviral treatment (ART) naive HIV positive patients in a tertiary care centre, South India. HIV Curr Res 2016;1:112.
24. Andia I, Pepper L, Matthieson P. Prevalence of renal disease in outpatients with HIV/AIDS in Mbarara Hospital. The 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment, Rio de Janeiro; 2005. p. 24-7.
25. Emem CP, Arogundade F, Sanusi A, Adelusola K, Wokoma F, Akinsola A. Renal disease in HIV-seropositive patients in Nigeria: An assessment of prevalence, clinical features and risk factors. Nephrol Dial Transplant 2008;23:741–6.
26. Emejulu A, Onwuliri V, Ojiako O. Electrolyte abnormalities and renal impairment in asymptomatic HIV-infected patients in owerri, South Eastern Nigeria. Australian J Basic Appl Sci 2011;5:257-60.
27. Franceschini N, Napravnik S, Eron JJ, Szczech LA, Finn WF. Incidence and aetiology of acute renal failure among ambulatory HIV-infected patients. Kidney Int 2005;67:1526–31.
28. Owiredu WK, Quaye BA, Amidu L, Addai-Mensah A. Renal insufficiency in Ghanaian HIV infected patients: need for dose adjustment. Afr Health Sci 2013;13:101–11.
29. Okuonghae PO, Olisekodiaka MJ, Onuegbu J, Amara AG, Aberare LO. Evaluation of renal function in HIV patients on antiretroviral therapy. Adv Lab Med Int 2011;1:25–31.
30. Obirikorang C, Osakunor DNM, Ntaadu B, Adarkwa OK. Renal function in ghanaian HIV-infected patients on highly active antiretroviral therapy: a case-control study. PLoS One 2014;9:e99469.
31. Manfredi R, Mastroianni A, Coronado OV, Chiodo F. Hyperuricemia and progression of HIV disease. J Acquir Immune Defic Syndr Hum Retrovirol 1996;12:318-9.
32. Manfredi R, Chiodo F. Longitudinal assessment of serum urate levels as a marker of HIV disease progression. Int J STD AIDS 1998;9:433-4.
33. Lambert JS, Seidlin M, Reichman RC, Plank CS, Laverty M, Morse GD, et al. 2Œ,3Œ-dideoxyinosine (ddI) in patients with the acquired immunodeficiency syndrome or AIDS-related complex. A phase I trial. N Engl J Med 1990;322:1333-40.
34. Ogundahunsi O, Akinyele OV, Ambali A, Mbacham W. The prevalence of renal disorder in HIV/AIDS patients on HAART. Int J Biomed Health Sci 2008;4:1-4.
35. Ukibe NR, Onyenekwe CC, Ahaneku JE, Ukibe SN, Meludu SC, Emelumadu FO. Evaluation of nutritional status of HIV infected females during menstrual cycle in Nnewi, Anambra state, Nigeria. Sci J Med Sci 2013;2:9.
36. Audu I, Agwale S, Tanimoto L, Womack C, Odama L, Leung K. Prevalence of HCV coinfection in HIV-infected individuals in nigeria and characterization of HCV genotypes. J Clin Virol 2004;31:S3-6.
37. Carolline AM, Maria FP, de Albuquerque M, de Alencar RA, de Melo HRL, Bandeira F. Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity. Cadernos De Saúde Pública 2011;27:1997-2008.
38. Anyabolu EN. BMI and risk factors of underweight and obesity in HIV subjects in Eastern Nigeria. World J AIDS 2011;6:8-15.
39. Madeddu G, Spanu A, Solinas P, Calia GM, Lovigu C, Chessa F. Bone mass loss and vitamin D metabolism impairment in HIV patients receiving highly active antiretroviral therapy. Quarterly J Nuclear Med Mol Imaging 2004;48:39-48.
40. Hendricks KM, Mwamburi DM, Newby PK, Wanke CA. Dietary patterns and health and nutrition outcomes in men living with HIV infection. Am J Clin Nutr 2008;88:1584-92.
41. American Dietetics Association. Position of the American Dietetic Association and Dietitians of Canada: Nutrition Intervention in the Care of Persons with Human Immunodeficiency Virus Infection. J Am Dietetic Assoc 2004;104:1425-41.
42. Dutra CDT, Libonati MF. Abordagemmetabólica e nutricional da lipodistrofiaemuso da terapia anti-retroviral. Rev Nutr 2008;21:239-46.
43. Johnson GP, Castrillon FJD, Ospina S. Alteraciones nutricionales en adultos infectados por el virus de la inmunodeficiencia humana. Perspectivas en Nutricion Humana 2004;12:23-37.
44. Schwartz EJ, Szczech LA, Ross MJ, Klotman ME, Winston JA, Klotman PE. Highly active antiretroviral therapy and the epidemic of HIV+End-stage renal disease. J Am Soc Nephrol 2005;16:2412-20.
45. Szczech LA, Gange SJ, Van-Der-Horst C, Bartlett JA, Young M, Cohen MH. Predictors of proteinuria and renal failure among women with HIV infection. Kidney Int 2002;61:195–202.
46. Kimmel PL. Pathogenesis and treatment of HIV–associated renal disease: lessons from clinical and animal studies, molecular pathologic correlations, and genetic investigations. Ann Int Med 2003;139:214-26.
47. Rao TK. Clinical features of human immunodeficiency virus 1991: Ray P, Lian X, Rakusanand T, Xue-Hui L. Nephrol, SectionSL45; 2004.
48. Pokala N, Dixit R, Manuhhai PM, Vijayala K. Adverse drug reactions with the second-line antiretroviral drug regimen. Asian J Pharm Clin Res 2014;7:75–9.
49. Kanai E, Hanabusa H. Renal tubular toxicity associated with tenofovir assessed using urine-beta 2 microglobulin alkaline phosphatase levels. AIDS 2005;19:203-3.
50. Cantor ES, Kimmel PL, Bosch JP. Effect of race on expression of acquired immunodeficiency-associated nephropathy. Arch Iran Med 1991;151:125–8.
51. Rao TK. Clinical features of human immunodeficiency virus associated nephropathy. Kidney Int 1991;40:S13–S18.
52. Pepper L, Andia I, Matthieson P. Prevalence of renal disease in patients attending the HIV/AIDS clinic at Mbarara University Teaching Hospital. Third International AIDS Society Conference on HIV Pathogenesis and Treatment, Rio de Janeiro, abstract TuPe15.3C02; 2004.
53. Ifeanyichukwu M, Onyenekwe CC, Elee PU, Ukibe NK, Meludu SC, Ezechukwu CC, et al. Evaluation of CD4 T-cell count, interleukin 6(IL-6) and interferon gamma in HIV infected symptomatic and asymptomatic individuals. J Biomed Invest 2007;5:70-3.
54. Ukibe NR, Onyenekwe CC, Ahaneku JE, Meludu SC, Ukibe SN, Ilika A, et al. CD4+T-cells count in HIV-malaria co-infection in adult population in Nnewi, South Eastern Nigeria. Int J Biol Chem Sci 2010;4:1593-601.
55. Afhami S. Renal disorders in HIV-infected patients. Arch Iran Med 2007;10:335–8.
56. Kamga HLF, Assob JCN, Njunda AL, Nde FP, Nsagha DS, Atanga MBS, et al. The kidney function trends in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients at the Nylon District Hospital, Douala, Cameroon. J AIDS HIV Res 2011;3:30-7.
57. Coca S, Perazella MA. Rapid communication: acute renal failure associated with tenofovir: evidence of drug-induced nephrotoxicity. Am J Med Sci 2002;324:342–4.
58. Peyrière H, Reynes J, Rouanet I, Daniel N, de Boever CM, Mauboussin JM, et al. Renal tubular dysfunction associated with tenofovir therapy: report of 7 cases. J Acquired Immune Defic Syndr 2004;35:269–73.
59. Bhatnagar S, Sharma H, Sharma VK. Study of adverse effects of anti-retroviral therapy in HIV naïve patients and their association with cd4 cell count. Asian J Pharm Clin Res 2013;6:122–3.
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How to Cite
Onwubuya, E. I., N. R. Ukibe, O. A. Kalu, S. N. Ukibe, and I. J. Obasi. “ASSESSMENT OF KIDNEY FUNCTION, ESTIMATED GLOMERULAR FILTRATION RATE AND BODY MASS INDEX IN HIV SEROPOSITIVE SUBJECTS ON ANTIRETROVIRAL THERAPY IN NNEWI”. International Journal of Pharmacy and Pharmaceutical Sciences, Vol. 10, no. 8, Aug. 2018, pp. 44-49, doi:10.22159/ijpps.2018v10i8.27291.
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