| dc.description.abstract | Motivation: The human immunodeficiency virus (HIV) is increasingly prevalent in South Africa,
with approximately 6.12 million people living with HIV. As a result of the high infection
rate, South Africa has the largest antiretroviral therapy (ART) roll-out programme,
providing ART to approximately 3.1 million people. The introduction of ART has
revolutionised the era of HIV in reducing the morbidity and mortality associated with
HIV or acquired immunodeficiency syndrome (AIDS) opportunistic disease. However,
after the introduction of ART, several studies reported metabolic derangements and
renal disease with the use of ART.
The metabolic syndrome (MetS) is frequently reported in HIV-infected individuals and
this population may be at higher risk due to the combination of HIV infection, ART and
traditional risk factors.
Renal disease has also been highlighted in people living with HIV. HIV infection may
directly infect the glomerular epithelial cells and podocytes, inducing renal injury. The
ART is also potentially nephrotoxic and may augment the effect exerted by HIV and
pre-existing kidney diseases.
The MetS and kidney disease have been reported in HIV-infected individuals,
however, it has not been fully elucidated how kidney function is affected by HIV, ART
and the MetS. Apart from HIV, the MetS and kidney disease have important public
health implications as both are associated with increased risk of cardiovascular
disease. As a result, these comorbidities may complicate the progression and
management of HIV. Studies reporting on the combined effects of HIV, the MetS and
renal function among the African population are scant.
Aim: In this study, we therefore determined the prevalence of the MetS and the association
thereof with renal function in an African cohort infected with HIV for at least five years.
Methodology: We included 114 HIV-infected and 114 HIV-free participants matched for age, sex and
locality. This is a sub-study of the Prospective Urban and Rural Epidemiological study
(PURE) in South Africa, as approved by the Health Research Ethics Committee of the
North-West University (approval number: NWU-00035-16-S1 and NWU-00016-10-
A1). Of the 114 HIV-infected participants, 87 were infected for 10 years and 27 for 5
years. The HIV-infected participants on ART were using first-line regimen, namely a
fixed-dose combination of tenofovir, efavirenz and emtricitabine. Anthropometric
measurements such as height, weight and waist circumference (WC) were measured
according to standardised procedures prescribed by the International Society for the
Advancement of Kinathropometry, while body mass index (BMI) was also calculated.
Duplicate brachial blood pressure (BP) measurements were performed in a sitting
position, at an interval of five minutes, using the validated OMRON M6 (Omron
Healthcare, Kyoto, Japan). We also performed duplicate central systolic blood
pressures (cSBP) with the Sphygmocor XCEL device (Atcor Medical Pty. Ltd., Sydney,
Australia), with the participant in the supine position.
Blood collection was done by a qualified nurse after an overnight fast. We performed
biochemical analysis for serum glucose, total cholesterol, high-density lipoprotein
cholesterol, low density lipoprotein cholesterol, γ-glutamyl transferase and C-reactive
protein. Mid-stream spot urine was used to determine albumin and creatinine levels
and we calculated creatinine clearance (CrCl), estimated glomerular filtration rate
(eGFR), and calculated urinary albumin-creatinine ratio (uACR). HIV status was
determined from whole blood, according to the South African Department of Health
guidelines. We defined the MetS using the criteria of the International Diabetes
Federation.
Results:
The prevalence of the MetS was lower in the HIV-infected participants (77.3% of the
HIV-infected were on ART) as compared to their uninfected counterparts (28% vs.
44%, p=0.0013). The HIV-infected group had lower BMI and WC (all p<0.001), as well
as lower cSBP and branchial blood pressure (all p≤ 0.021). With regard to renal
function, the CrCl was higher in the HIV-infected participants compared to their
uninfected counterparts (p<0.001). There was no difference in eGFR and uACR in the two groups (p=0.99 and p=0.72 respectively). When adjustment was done for WC, the
cSBP (p<0.001) and brachial blood pressure remained significant (p=0.05), and CrCl,
eGFR and uACR were similar (p>0.27).
With regard to the use of ART, the HIV-infected participants taking ART also presented
with lower cSBP and brachial blood pressures (all p=0.01). CrCl was lower in the HIVinfected
participants taking ART than the uninfected participants (p=0.002), whereas
eGFR and uACR were similar between the two groups (all p>0.11).
When we compared HIV-infected and uninfected participants with the MetS, the blood
pressures were similar (all p>0.46). Of those with the MetS, 46% and 17% of the HIVinfected
and the uninfected participants respectively had microalbuminuria. The HIVinfected
participants and those with the MetS had 43% higher uACR compared to the
uninfected participants with the MetS (p=0.032). CrCl was lower in the HIV-infected
group with the MetS than the uninfected group with the MetS (p=0.05), but eGFR was
not different between these two groups (p=0.21).
General conclusion:
HIV-infected participants with the MetS had a twofold higher uACR compared to their
uninfected counterparts, despite similar age and sex distribution and a lower
prevalence of the MetS. These findings suggest that a combination of the MetS and
HIV may alter glomerular permeability. The presence of the MetS and renal
dysfunction may therefore increase the risk of cardiovascular disease in the HIVinfected
population. | en_US |
