A Study on Prevalence of Microalbuminuria in HIV patients not on ART and correlation with CD4 count

Maliyappa, Vijay Kumar (2009) A Study on Prevalence of Microalbuminuria in HIV patients not on ART and correlation with CD4 count. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : Human Immunodeficiency Virus (HIV) infection is spreading worldwide in pandemic proportions. It manifests from an asymptomatic state to AIDS. Involvement of multiple organs is well documented. Renal involvement occurs due to infection per se or due to associated problems like opportunistic/co-infections, septicaemia, drug toxicity. Renal disease was first reported in HIV-1–seropositive individuals in 1984, and initial reports identified focal segmental glomerulo-sclerosis (FSGS) and other renal disease. Renal involvement is seen in all stages of infection presenting as fluid and electrolyte imbalance, HIV associated nephropathy (HIVAN) progressing to End Stage renal Disease (ESRD). Survival of patients with HIV after HAART therapy has been introduced, has increased and so are the number of HIV cases with Chronic Kidney Disease (CKD). Cohort studies suggest that approximately 30% of HIV-positive individuals have proteinuria (≥ 1+). Microalbuminuria is an independent and earliest marker of renal involvement and loss of endothelial integrity. Overall microalbuminuria is seen in ~ 20% (varying from 9% to 30% in various studies) of untreated HIV infected patients. Microalbuminuria levels showed correlation with CD4 T cell count suggesting an association between the progression of disease and microalbuminuria. Present study was undertaken to confirm or refute the earlier reports. AIM & OBJECTIVES : 1. To estimate the prevalence of microlalbuminuria in HIV patients. 2. To correlate prevalence of microalbuminuria with CD4 cell count. MATERIALS AND METHODS : Setting: This study was carried out at Government Kilpauk Medical College & Hospital, Chennai . Collaborating department: ART Centre & Department of Internal Medicine. Study design : Cross Sectional Study. Period of study : January 2008 - September 2008. Sample size : 80 cases. Ethical Committee Approval : Obtained. Informed Consent : Obtained. Conflict of Interest : There was no conflict of interest. Financial Support : Nil. Selection and details of study subjects : The study was conducted in HIV positive patients who were attending the ART clinic, Government Kilpauk Medical College & Hospital, Chennai. Inclusion criteria : Adult male & non pregnant female HIV infected patients before ART therapy. Exclusion criteria : Children, Overt renal disease, Diabetes mellitus, Systemic hypertension, Collagen vascular disease, Urinary tract infection, Hepatitis, Patients on nephrotoxic agents, Patient not willing for study. The total number of HIV positive patients screened were 270, of which 90 patients had Tuberculosis infection (pulmonary & extra pulmonary) and they were on Anti Tuberculosis Treatment, so they were excluded from study. 35 patients who had Diabetes Mellitus were excluded from the study. 27 cases were associated with Systemic Hypertension and hence where excluded from the study. The patients with NSAID abuse were found to be 16 in numbers and they were excluded from study. 10 patients were found to be having Overt Renal Disease and they were excluded from the study. 12 patients had Urinary Tract Infection evidenced by urinary examination and they were excluded from the study. After exclusion of these patients, the number of patients selected for our study was 80. They were divided into 2 groups according toCD4 count. 40 patients with CD4 count of ≤ 350 cells/ μL were grouped as Group A. Similarly 40 patients with CD4 count of > 350 cells/μL were grouped as Group B. RESULTS : A total of 80 HIV seropositive patients were studied. They were divided into two groups. • Group A included 40 HIV seropositive patients with CD4 cell count ≤ 350/ μL (n=40). • Group B included 40 HIV seropositive patients with CD4 cell count > 350/ μL (n=40). • Mean CD4 count of study group was 387.7 ± 193.78 cells/μL (Group A – 236.75 ± 79.77 cells/μL. Group B – 538.65 ± 151.53 cells/μL.). • Out of 80 patients 41 (51.25%) were males ( Group A – 21, Group – B 20) and 39 (48.75%) were females (Group A -19, Group B – 20). • Mean age group of study population was 33.85 ± 8.26 years (Group A – 35.65 ± 9.80 years. Group B – 32.05 ± 6.46years). • House wives and others constituted the majority of study group occupation about 35% and 40% respectively. • Heterosexual route was the most common mode of transmission of HIV infection about 91.25%. • Mean BMI of study group was 21.66 ± 3.33 kg/m2 (Group A – 19.92 ± 2.65 kg/m2. Group B 22.4 ± 4.02 kg/m2). • None of the patients in study group had symptoms pertaining to renal pathology. • Nine patients (11.25%) (Group A - 9; Group B - 0) had Microalbuminuria. • Six patients (7.5%) (Group A - 6; Group B - 0) had Overt proteinuria. • Eight patients (10%) (Group A - 7; Group B - 1) had elevated levels of Serum Creatinine. • Significant correlation was found between microalbuminuria and CD4 count. • No significant correlation was found between microalbuminuria and Age, Sex, Body Mass Index & WHO staging. CONCLUSION : Microalbuminuria was significantly elevated in the study group, seen in 11.25% of cases. The mean urine microalbumin value was 37.95 mg/day. The prevalence of elevated urine albumin creatinine ratio amounting to microalbuminuria was 11.25% in the study group. The mean urine albumin creatinine ratio was 36.78 mg/gm. The microalbuminuria specifically correlated with CD4 counts, 9 out of 9 in the study group were found to have CD4 count ≤ 350/μL. Serum Creatinine levels were elevated in 8 patients, out of whom 7 were found to have CD4 count ≤ 350/μL. Overt proteinuria was present in 7.5% in the study group. Electrolyte abnormalities were not found in our study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Microalbuminuria, HIV patients, ART, CD4 count.
Subjects: MEDICAL > General Medicine
Depositing User: Pushparaj A
Date Deposited: 13 Jul 2017 11:15
Last Modified: 04 Feb 2018 02:11
URI: http://repository-tnmgrmu.ac.in/id/eprint/1544

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