Monitoring Of Highly Active Antiretroviral Therapy Among Asymptomatic Hiv-Infected Patients In Akwa-Ibom: Effect On Liver And Kidney Functions


  • Olugbenga M. Ajulo Department of Clinical Pharmacy & Biopharmacy
  • Chinyere Nwamuramu


Toxicity, Liver, Kidney, HIV, HAART


Introduction: New target is driven at achieving 90-90-90 treatment goal by 2020, whereby 90% of HIV-infected persons will know their HIV status, access HAART and have viral suppression. Improved access to HAART in sub-Saharan Africa led to the emergence of HAART-related toxicity and its management as component of HIV care in developing countries. The aim of this study was to evaluate the effects of HAART on liver and kidney of HIV-infected adult participants in a secondary healthcare facility.

Method: The participants came to the hospital after 3 months of adherence to the Highly Active Anti-retroviral Therapy (HAART) where phlebotomist collected 3mL blood from venous circulation for analysis of biochemical parameters. The blood samples were spun to obtain sera which were used for determining the amount of ALT, AST and creatinine by using ALT, AST and creatinine kits made by Randox® laboratory limited, United Kingdom. Creatinine clearance was calculated by using Cockcroft-Gault equation.

Result: ALT of 198 HIV-infected participants on HAART (11.21±9.78IU/L) was significantly (p=0.01) elevated than the 74 control participants (6.28±5.17IU/L). AST of HIV-infected participants on HAART (18.51±10.38IU/L) was significantly (p=0.00)  elevated than the control participants (13.43±6.07IU/L). Creatinine clearance of HIV-infected participants on HAART (79.19±72.27mL/min/1.732m2) was significantly (p=0.00) reduced than the control participants (132.34±53.06mL/min/1.732m2).

Conclusion: Both biochemical parameters of liver were significantly elevated in HIV-infected participants on HAART which indicated hepatotoxicity. The biochemical parameter of kidney, creatinine clearance was significantly reduced in HIV-infected participants on HAART indicating renotoxicity.

Author Biographies

Olugbenga M. Ajulo, Department of Clinical Pharmacy & Biopharmacy

Faculty of Pharmacy, University of Uyo, Uyo. Akwa-Ibom State, Nigeria

Chinyere Nwamuramu

Faculty of Pharmacy, University of Uyo, Uyo. Akwa-Ibom State, Nigeria


Joint United Nations Programme on HIV/AIDS (2016). Global AIDS update. Geneva. Accessed on December 23, 2016.

Apanga S, Punguyire D, Adjei G (2012). Estimating the cost to rural ambulating HIV/AIDS patients on Highly Active Antiretroviral Therapy (HAART) in rural Ghana: a pilot study. Pan African Medical Journal 12:21. Accessed on April 15, 2016.

Joint United Nations Program on HIV/AIDS (2013). Report on the global AIDS epidemic. Geneva. Accessed on November 11, 2016.

Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC,Kumarasamy N et al. (2011). Prevention of HIV-1 Infection with Early Antiretroviral Therapy. New Eng J Med 365:493-505.

Suthar AB, Lawn SD, Amo J, Getahun H, Dye C et al. (2012). Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis. PLoS Med, 9:e1001270. Accessed on January 12, 2017.

Barth RE, van der Loeff MFS, Schuuman R, Hoepelman AIM, Wensing AMJ (2010). Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review. Lancet Infect Disease 10: 155-166.

World Health Organisation (2013). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. Accessed November 20, 2016.

World Health Organisation (2016). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a Public Health Approach, Second Accessed October 1, 2017.

Hirschhorn LR, Kaaya SF, Garrity PS, Chopyak E, Fawzi MCS (2012). Cancer and the “other” noncommunicable chronic diseases in older people living with HIV/AIDS in resource-limited settings: a challenge to success. AIDS 26 (Suppl. 1):S65–75.

Haregu T, Oldenburg B, Sestwe G, Elliott J, Nanayakkara V (2012). Epidemiology of comorbidity of HIV/AIDS and non-communicable diseases in developing countries: a systematic review. J Glob Health Care Syst. 2:142.

Nigatu T (2012). Integration of HIV and noncommunicable diseases in health care delivery in low- and middle- income countries. Prev Chron Dis. 9:E93.

The Antiretroviral Therapy Cohort Collaboration (2010). Causes of death in HIV-1 infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 15:1387–1396.

Rodger A, Bruun T, Cambiano V, Vernazza P, Estrada V, Van Lunzen J et al (2014). HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER Study. In: 21st Conference on Retroviruses and Opportunistic Infections, Boston, MA, USA (oral late breaker abstract 153LB).

The TEMPRANO ANRS 12136 Study Group (2015). A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 373:795–807.

The INSIGHT START Study Group (2015). Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 373:808–822.

Subbaraman R, Chaguturu SK, Mayer KH, Flanigan TP and Kumarasamy N (2007). Adverse Effects of Highly Active Antiretroviral Therapy in Developing Countries. Clinical Infectious Diseases 45:1093–1101.`

Pollard RB, Robinson P, Dransfield K (1998). Safety profile of nevirapine, a nonnucleoside reverse transcriptase inhibitor for the treatment of human immunodeficiency virus infection. Clin Ther 20: 1071–1092.

Martinez E, Blanco JL, Arnaiz JA, et al. (2001). Hepatotoxicity in HIV-1–infected patients receiving nevirapine-containing antiretroviral therapy. AIDS 15:1261–1268.

Stern JO, Robinson PA, Love J, Lanes S, Imperiale MS, Mayers DL. (2003). A comprehensive hepatic safety analysis of nevirapine in different populations of HIV infected patients. J Acquir Immune Defic Syndr 34(Suppl 1):S21–33.

Wit FW, Weverling GJ, Weel J, Jurriaans S, Lange JM (2002). Incidence of and risk factors for severe hepatotoxicity associated withantiretroviral combination therapy. J Infect Dis 186:23–31.

Kumarasamy N, Lai A, Cecelia AJ et al. (2004). Toxicities and adverse events following generic HAART in south Indian HIV-infected individuals [abstract P189]. In: Proceedings of the 7th International Congress on Drug Therapy and HIV Infection (Glasgow, United Kingdom).

Severe P, Leger P, Charles M, et al. (2005). Antiretroviral therapyinathousand patients with AIDS in Haiti. N Engl J Med 353:2325–2334.

Anekthananon T, Ratanasuwan W, Techasathit W, Sonjai A, Suwan- agool S. (2004). Safety and efficacy of a simplified fixed-dose combination of stavudine, lamivudine and nevirapine (GPO-VIR) for the treatment of advanced HIV-infected patients: a 24-week study. J Med AssocThai 87:760–767.

Pujari SN, Patel AK, Naik E, et al. (2004). Effectiveness of generic fixed-dose combinations of highly active antiretroviral therapy for treatment of HIV infection in India. J Acquir Immune Defic Syndr 37: 1566–1569.

van Oosterhout JJ, Bodasing N, Kumwenda JJ, et al. (2005). Evaluation of antiretroviral therapy results in a resource-poor setting in Blantyre, Malawi. Trop Med Int Health; 10: 464–470.

Cantrell R, Chi B, Mulenga L, et al. (2006). Incidence and predictors of hepatotoxicity among patients receiving nevirapine (NVP)– containing antiretroviral therapy (ART) in Zambia [abstract WEPE0172]. In: Program and abstractsof the16thInternationalAIDS Conference (Toronto, Canada). Toronto, Canada: International AIDS Society.

Sanne I, Mommeja-Marin H, Hinkle J, et al. (2005). Severe hepatotoxicity associated with nevirapine use in HIV-infected subjects. J Infect Dis; 191:825–829.

Randox Laboratories Ltd (2007). Manual AS 101. Crumlin, County Antrim, United

Cock-croft DW and Gault MH (1976). Predictions of creatinine clearance from serum creatinine. Nephron 16 (1): 31-41.

Ugiagbe RA, Malu AO, Bojuwoye BJ and Onunu AN (2012). Incidence of hepatotoxicity of highly active antiretroviral therapy in tertiary health center in Nigeria. Nigeria postgradraduate Medical Journal 19(3): 127-132.

Puoti M, Torti C, Ripamonti D, Castelli F, Zaltron S, Zanini B, Spinetti A, Putzolu V, Casari S, Tomasoni L, Quiros-Roldan E, Favret M, Berchich L, Grigolato P, Callea F, and Carosi G. (2003). Severe hepatotoxicity during combination antiretroviral treatment: Incidence, liver histology and outcome. Journal of Acquired Immune Deficiency Syndromes 32: 259-267.

Sabin CA, Ryom L, Kovari H, Kirk O, de Wit S, Law M, Reiss P, Dabis F, Pradier C, El-Sadr Wafaa, Monforte A, Kamara D, Philips AN, and Lungred JD (2013). Association between ALT level and the rate of cardio/cerebrovascular events in HIV positive individuals: D:A:D Study. J.Acquir Immun Defic Syndr 63(4)

Menezes AM, Torelly J Jr, Real L, Bay M, Poeta J, Sprinz E (2011). Prevalence and risk factors associated to chronic kidney disease in HIV-infected patients on HAART and undetectable viral load in Brazil. PLoS ONE 6(10):

Brennan A, Evans D, Maskew M, Naicker S, Ive P, Sanne I, Maotoe T, and Fox M (2011). Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir. AIDS 25(13):1603-1609.




How to Cite

M. Ajulo, O. ., & Nwamuramu, C. . (2017). Monitoring Of Highly Active Antiretroviral Therapy Among Asymptomatic Hiv-Infected Patients In Akwa-Ibom: Effect On Liver And Kidney Functions. The Nigerian Journal of Pharmacy, 51(2). Retrieved from