Assessment of Renal Function among HIV-Infected Patients on Combination Antiretroviral Therapy at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
Background: Acquired immunodeficiency syndrome (AIDS) is a spectrum of disease states characterized by progressive immunosuppression. Sub-Saharan Africa is heavily affected by human immunodeficiency virus (HIV) and AIDS than any other region of the world. Renal complications are important component of advanced HIV disease, and these complications significantly contribute to morbidity and mortality in HIV/AIDS patients. Aim of the Study: To assess renal function abnormalities in HIV infected patients and compare with treatment-naive and HIV-negative control groups. Methods: A retrospective cross sectional study of comparative nature was designed and samples and biochemical data were collected from July 1/2012 to February 1/2013 in patients attending the ART clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Renal functions of 180 participants were assessed. The data obtained were analyzed using SPSS version 16.0. Result: A total of 180 participants grouped as HIV-negative controls (n = 60), HIV+ treatment-naive (n = 60) and HIV+ on HAART were recruited to participate in this study. Out of 180 participants included in the study, 59 (32.78%) were males and the remaining 121 (67.22%) were females. Mean serum total protein was higher in patients on HAART groups (5.78 ± 1.39) than treatment-naive (4.76 ± 2.19). There was significant reduction (p < 0.05) in serum total protein in both HIV+ groups as compared with the control groups. The mean serum creatinine level was not significantly different among three groups. The mean serum creatinine clearance in treatment-naive groups (111.05 ± 11.33) was lower than the control groups (115.05 ± 44.41) and patients on HAART (114.76 ± 28.54). There was a positive and significant correlation of glomerular filtration rate with BMI on treatment-naive groups. Conclusion: There are no statistically significant differences in the levels of Creatinine clearance and Estimated Glomerular Filtration Rate (eGFR) in HIV positive patients (naive as well as treated) as compared to the negative controls. The prevalence of renal impairment as defined by CrCl < 60 mL/min (eGFR < 60 ml/min/1.73 m2) is higher in treatment-naive participants than those on HAART and HIV-negative control groups.
References
[1]
Armstrong, S., Squarey, S. and Fontaine, C. (2004) UNAIDS 2004 Report on Global AIDS Epidemic. Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva.
[2]
UNAIDS (2012) Report on the Global AIDS Epidemic. Geneva.
[3]
WHO Report on AIDS 2005 UNAIDS and WHO (2005) Joint United Nations Programme on HIV/AIDS.
[4]
UNAIDS (2011) World AIDS Day Report 2011. Geneva.
[5]
USAID/Ethiopia (2015) HIV/AIDS Health Profile of Ethiopia
http://www.ethiopiaatransition.usaid.gov/president%E2%80%99s-emergency-5programaids-relief-pepfar
[6]
USAID (2014) Healthy Policy Initiative Equity and Access to ART in Ethiopia. The Joint United Nations Programme on HIV/AIDS. http://www.unaids.org/en/HIV/Data/
[7]
Winston, J., Deray, G., Hawkins, T., Szczech, L., Wyatt, C. and Young, B. (2008) Kidney Disease in Patients with HIV Infection and AIDS. Clinical Infectious Diseases, 47, 1449-1457. http://dx.doi.org/10.1086/593099
[8]
Rao, T. (1998) Acute Renal Failure in Human Immunodeficiency Virus Infection. Seminars in Nephrology, 18, 378- 395.
[9]
Glassock, R., Cohen, A., Danovitch, G. and Parsa, K. (1990) Human Immunodeficiency Virus and the Kidney. Ann Intern med, 112, 35-49. http://dx.doi.org/10.7326/0003-4819-112-1-35
[10]
Lu, T. and Ross, M. (2005) HIV-Associated Nephropathy: A Brief Review. Mount Sinai Journal of Medicine, 72, 193-199.
[11]
Ahuja, T., Borucki, M., Funtanilla, M., Shahinian, V., Hollander, M. and Rajaraman, S. (1999) Is the Prevalence of HIV-Associated Nephropathy Decreasing? American Journal of Nephrology, 19, 655-659.
http://dx.doi.org/10.1159/000013537
[12]
Kopp, J., Falloon, J., Filie, A., Abati, A., King, C., Hortin, G., Mican, J., Vaughan, E. and Miller, K. (2002) Indinavir-Associated Interstitial Nephritis and Urothelial Inflammation: Clinical and Cytologic Findings. Clinical Infectious Diseases, 34, 1122-1128. http://dx.doi.org/10.1086/339486
[13]
Afhami, S., Rasoulinejad, M., Razeghi, E., Shahriari, S. and Esmailpour, N. (2007) Renal Disorders in HIV-Infected Patients. Archives of Iranian Medicine, 10, 335-338.
[14]
Ogundahunsi, O., Akinyele, Oyegunle, V., Ambali, A. and Mbacham, W. (2008) The Prevalence of Renal Disorder in HIV/AIDS Patients on HAART. International Journal of Biomedical and Health Sciences, 4, 1-4.
[15]
Lucas, G., Lau, B., Atta, M., Fine, D., Keruly, J. and Moore, R. (2008) Chronic Kidney Disease Incidence, and Progression to End Stage Renal Disease, in HIV-Infected Individuals: A Tale of Two Races. The Journal of Infectious Diseases, 197, 1548-1557. http://dx.doi.org/10.1086/587994
[16]
Coresh, J., Astor, B., Greene, T., Eknoyan, G. and Levey, A. (2003) Prevalence of Chronic Kidney Disease and Decreased Kidney Function in the Adult Us Population: Third National Health and Nutrition Examination Survey. American Journal of Kidney Diseases, 41, 1-12. http://dx.doi.org/10.1053/ajkd.2003.50007
[17]
Lucas, G., Eustace, J., Sozio, S., Mentari, E., Appiah, K. and Moore, R. (2004) Highly Active Antiretroviral Therapy and the Incidence of HIV-1-Associated Nephropathy: A 12-Year Cohort Study. AIDS, 18, 541-546.
http://dx.doi.org/10.1097/00002030-200402200-00022
[18]
Gazzaruso, C., Bruno, .R, Garzaniti, A., Giordanetti, S., Fratino, P., Sacchi, P. and Filice, G. (2003) Hypertension among HIV Patients: Prevalence and Relationships to Insulin Resistance and Metabolic Syndrome. Journal of Hypertension, 21, 1377-1382. http://dx.doi.org/10.1097/00004872-200307000-00028
[19]
Brown, T., Li, X., Cole, S., Kingsley, L., Palella, F., Riddler, S., Chmiel, J., Visscher, B., Margolick, J. and Dobs, A (2005) Cumulative Exposure to Nucleoside Analogue Reverse Transcriptase Inhibitors Is Associated with Insulin Resistance Markers in the Multicenter AIDS Cohort Study. AIDS, 19, 1375-1383.
http://dx.doi.org/10.1097/01.aids.0000181011.62385.91
[20]
Coresh, J., Byrd-Holt, D., Astor, B., Briggs, J., Eggers, P., Lacher, D. and Hostetter, T. (2005) Chronic Kidney Disease Awareness, Prevalence, and Trends among US Adults, 1999 to 2000. Journal of the American Society of Nephrology, 16, 180-188. http://dx.doi.org/10.1681/ASN.2004070539
[21]
Shamu, T., Wellington, M., Pascoe, M., Gwanzura, L. and Ndhlovu, C.E. (2015) Incidence of Nephropathy in HIV Infected Patients Receiving Highly Active Antiretroviral Therapy at Newlands Clinic: A Retrospective Study. World Journal of AIDS, 5, 113-123. http://dx.doi.org/10.4236/wja.2015.52014
[22]
Belay, E., Seifu, D., Amogne, W. and Kibret, K.T. (2014) Lipid Profile Derangements among Human Immunodeficiency Virus Infected Adults Receiving First Line Anti-Retroviral Therapy in Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia: Comparative Cross-Sectional Study. Journal of AIDS & Clinical Research, 5, 328.
[23]
Roling, J., Schmid, H., Fischereder, M., Draenert, R. and Goebel, F. (2006) HIV-Associated Renal Diseases and Highly Active Antiretroviral Therapy-Induced Nephropathy. Clinical Infectious Diseases, 42, 1488-1495.
http://dx.doi.org/10.1086/503566
[24]
Verhelst, D., Monge, M., Meynard, J., Fouqueray, B., Mougenot, B., Girard, P., Ronco, P. and Rossert, J. (2002) Fanconi Syndrome and Renal Failure Induced By Tenofovir: A First Case Report. American Journal of Kidney Diseases, 40, 1331-1333. http://dx.doi.org/10.1053/ajkd.2002.36924
[25]
Izzedine, H., Launay-Vacher, V. and Deray, G. (2005) Antiviral Drug Induced Nephrotoxicity. American Journal of Kidney Diseases, 45, 804-817. http://dx.doi.org/10.1053/j.ajkd.2005.02.010
[26]
McComsey, G.A., Kitch, D., Daar, E.S., Tierney, C., Jahed, N.C., Melbourne, K., Ha, B., Brown, T.T., Bloom, A., Fedarko, N. and Sax, P.E. (2012) Inflammation Markers after Randomization to Abacavir/Lamivudine or Tenofovir/Emtricitabine with Efavirenz or Atazanavir/Ritonavir. AIDS, 26, 1371-1385.
http://dx.doi.org/10.1097/QAD.0b013e328354f4fb
[27]
Chaves, H.L., Batista, M.P., Gomes, A.M., Costa, A.A., Lima, A.T., Ceara, V.D.A., Caravalho, P.R.A., Sampio, L.A., Bezerra, F.M. and Medeiros, M.S. (2014) Microalbuminuria and Kidney Disease Risk in HIV-Patients Taking Combined Antiretroviral Therapy. World Journal of AIDS, 2014, 4, 242-248. http://dx.doi.org/10.4236/wja.2014.42029
[28]
Berns, J., Cohen, R., Silverman, M. and Turner, J. (1997) Acute Renal Failure Due to Indinavir Crystalluria and Nephrolithiasis: Report of Two Cases. American Journal of Kidney Diseases, 30, 558-560.
http://dx.doi.org/10.1016/S0272-6386(97)90316-4
[29]
Kopp, J., Miller, K., Mican, J., Feuerstein, I., Vaughan, E., Baker, C., Pannell, L.K. and Falloon, J. (1997) Crystalluria and Urinary Tract Abnormalities Associated with Indinavir. Annals of Internal Medicine, 127, 119-125.
http://dx.doi.org/10.7326/0003-4819-127-2-199707150-00004
[30]
Gagnon, R., Tecimer, S., Watters, A. and Tsoukas, C. (2000) Prospective Study of Urinalysis Abnormalities in HIV-Positive Individuals Treated with Indinavir. American Journal of Kidney Diseases, 36, 507-515.
http://dx.doi.org/10.1053/ajkd.2000.9791
[31]
Lin, J., Chen, I., Vastag, K. and Ostovic, D. (1995) pH-Dependent Oral Absorption of L-735,524, a Potent HIV Protease Inhibitor, in Rats and Dogs. Drug Metabolism and Disposition, 23, 730-735.
[32]
Hortin, G., King, C., Miller, K. and Kopp, J. (2000) Detection of Indinavir Crystals in Urine: Dependence on Method of Analysis. Archives of Pathology & Laboratory Medicine, 124, 246-250.
[33]
Daudon, M., Estepa, L., Viard, J.P., Joly, D., Jungers, P. (1997) Urinary Stones in HIV-1-Positive Patients Treated with Indinavir. Lancet, 349, 1294-1295. http://dx.doi.org/10.1016/S0140-6736(05)62506-8
[34]
Winston, J., Deray, G., Hawkins, T., Szczech, L., Wyatt, C. and Young, B. (2008) Kidney Disease in Patients with HIV Infection and AIDS. Clinical Infectious Diseases, 47, 1449-1457. http://dx.doi.org/10.1086/593099
[35]
Carbone, L., D’Agati, V., Cheng, J. and Appel, G. (1989) Course and Prognosis of Human Immunodeficiency Virus-Associated Nephropathy. American Journal of Medicine, 87, 389-395.
http://dx.doi.org/10.1016/S0002-9343(89)80819-8
[36]
Gupta, S., Eustace, J. and Winston, J. (2005) Guidelines for the Management of Chronic Kidney Disease in HIV-Infected Patients: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases, 40, 1559-1585. http://dx.doi.org/10.1086/430257
[37]
Wools-Kaloustian, K., Gupta, S.K., Muloma, E., Owino-Ong’or, W., Sidle, J., Aubrey, R.W., Shen, J., Kipruto, K., Zwickl, B.E. and Goldman, M. (2007) Renal Disease in An Antiretroviral-Naive HIV-Infected Outpatient Population in Western Kenya. Nephrology Dialysis Transplantation, 22, 2208-2212. http://dx.doi.org/10.1093/ndt/gfm223
[38]
Bartels, H. and BÖhmer, M. (1971) Micro-Determination of Creatinine. Clinica Chimica Acta, 32, 81-85.
[39]
Levey, A., Coresh, J., Greene, T., Stevens, L., Zhang, Y., Hendriksen, S., Kusek, J. and van Lente, F. (2006) Chronic Kidney Disease Epidemiology Collaboration. Using Standardized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate. Annals of Internal Medicine, 145, 247-254.
http://dx.doi.org/10.7326/0003-4819-145-4-200608150-00004
[40]
Fossati, P., Prencipe, L. and Berti, G. (1980) Use of 3,5-Dichloro-2 Hydroxy-Benzenesulfonic Acid/4-Aminophena-zone Chromogenic System in Direct Enzymic Assay of Uric Acid in Serum and Urine. Clinical Chemistry, 26, 227- 231.
[41]
Cockcroft, D. and Gault, M. (1976) Prediction of Creatinine Clearance from Serum Creatinine. Nephron, 16, 31-41.
http://dx.doi.org/10.1159/000180580
[42]
Cohen, S., Cukor, D., Peterson, R. and Kimmel, P. (2007) Psychosocial Aspects of Chronic Disease: ESRD as a Paradigmatic Illness. Journal of the American Society of Nephrology, 18, 3042-3055.
http://dx.doi.org/10.1681/ASN.2007030345
[43]
Eggers, P. and Kimmel, P. (2004) Is There an Epidemic of HIV Infection in the US ESRD Program? Journal of the American Society of Nephrology, 15, 2477-2485. http://dx.doi.org/10.1097/01.ASN.0000138546.53152.A7
[44]
Coresh, J., Hallan, S., Astor, B., Romundstad, S., AasarØd, K., Kvenild, K. and Coresh, J. (2007) Association of Kidney Function and Albuminuria with Cardiovascular Mortality in Older vs Younger Individuals: The HUNT II Study. Archives of Internal Medicine, 167, 2490-2496. http://dx.doi.org/10.1001/archinte.167.22.2490
[45]
D’agati, V., Suh, J., Carbone, L., Cheng, J. and Appel, G. (1989) Pathology of HIV-Associated Nephropathy: A Detailed Morphologic and Comparative Study. Kidney International, 35, 1358-1370.
http://dx.doi.org/10.1038/ki.1989.135
[46]
Shaninian, V. (2000) Prevalence of HIV-Associated Nephropathy in Autopsies of HIV-Infected Patients. American Journal of Kidney Diseases, 35, 884-888. http://dx.doi.org/10.1016/S0272-6386(00)70259-9
[47]
Behar, D., Shlush, L., Maor, C., Lorber, M. and Skorecki, K. (2006) Absence of HIV Associated Nephropathy in Ethiopians. American Journal of Kidney Diseases, 47, 88-94. http://dx.doi.org/10.1053/j.ajkd.2005.09.023
[48]
Phillips, L., Allen, N., Phillips, B., Abera, A., Diro, E., Riley, S., Tadesse, Y., Williams, J. and Phillips, A. (2013) Acute Kidney Injury Risk Factor Recognition in Three Teaching Hospitals in Ethiopia. South African Medical Journal, 103, 413-418. http://dx.doi.org/10.7196/samj.6424
[49]
Girma, J., Umeta, M. and Tsegaye, A. (2015) Effect of 1st Line Highly Active Anti-Retroviral Therapy (HAART) on the Development of Renal Failure in Human Immunodeficiency Virus (HIV)-Infected Patients Attending ART Clinic of St. Paul’s General Specialized Hospital, Addis Ababa: A Retrospective Cross Sectional Study. CIBTech Journal of Pharmaceutical Sciences, 4, 32-42. http://www.cibtech.org/cjps.htm
[50]
Audu, I., Agwale, S., Tanimoto, L., Womack, C., Odama, L., Leung, K., Duey, D., Negedu-Momoh, R., Mohammed, S., Inyang, U., Graham, B. and Ziermann, R. (2004) Prevalence of HCV Coinfection in HIV-Infected Individuals in Nigeria and Characterization of HCV Genotypes. Journal of Clinical Virology, 31, S3-S6.
http://dx.doi.org/10.1016/j.jcv.2004.09.001
[51]
Macallan, D.C. (1999) Nutrition and Immune Function in Human Immunodeficiency Virus Infection. Proceedings of the Nutrition Society, 58, 743-748. http://dx.doi.org/10.1017/S002966519900097X
[52]
Emem, C., Arogundade, F., Sanusi, A., Adelusola, K., Wokoma, F. and Akinsola, A. (2008) Renal Disease in HIV-Seropositive Patients in Nigeria: An Assessment of Prevalence, Clinical Features and Risk Factors. Nephrology Dialysis Transplantation, 23, 741-746. http://dx.doi.org/10.1093/ndt/gfm836
[53]
Emejulu, A., Onwuliri, V. and Ojiako, O. (2011) Electrolyte Abnormalities and Renal Impairment in Asymptomatic HIV-infected Patients in Owerri, South Eastern Nigeria. Australian Journal of Basic and Applied Sciences, 5, 257-260.
[54]
Andia, I., Pepper, L. and Matthieson, P. (2005) 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, 24-27 July 2005.
[55]
Wali, R., Drachenberg, C., Papadimitriou, J., Keay, S. and Ramos, E. (1998) HIV-1-Associated Nephropathy and Response to Highly-Active Antiretroviral Therapy. Lancet, 352, 783-784.
http://dx.doi.org/10.1016/S0140-6736(98)24037-2
[56]
Kirchner, J. (2002) Resolution of Renal Failure after Initiation of HAART: 3 Cases and a Discussion of the Literature. AIDS Reader, 12, 103-105, 110-112.
[57]
Schwartz, G. and Furth, S. (2007) Glomerular Filtration Rate Measurement and Estimation in Chronic Kidney Disease. Pediatric Nephrology, 22, 1839-1848. http://dx.doi.org/10.1007/s00467-006-0358-1
[58]
Schwartz, E.J., Szczech, L.A., Ross, M.J., Klotman, M.E., Winston, J.A. and Klotman, P.E. (2005) Highly Active Antiretroviral Therapy and the Epidemic of HIV+ End-Stage Renal Disease. Journal of the American Society of Nephrology, 16, 2412-2420. http://dx.doi.org/10.1681/ASN.2005040340
[59]
Szczech, L., Edwards, L., Sanders, L., van der Horst, C., Bartlett, J., Heald, A. and Svetkey, L. (2002) Protease Inhibitors Are Associated with a Slowed Progression of HIV-Related Renal Diseases. Clinical Nephrology, 57, 336-341.
http://dx.doi.org/10.5414/CNP57336
[60]
Kimmel, P. (2003) Pathogenesis and Treatment of HIV-Associated Renal Disease: Lessons from Clinical and Animal Studies, Molecular Pathologic Correlations, and Genetic Investigations. Annals of Internal Medicine, 139, 214-226.
http://dx.doi.org/10.7326/0003-4819-139-3-200308050-00019
[61]
Kanai, E. and Hanabusa, H. (2005) Renal Tubular Toxicity Associated with Tenofovir Assessed Using Urine-Beta 2 Micro Globulin Alkaline Phosphatase Levels. AIDS, 19, 2031-2033.
http://dx.doi.org/10.1097/01.aids.0000194130.05264.83
[62]
Weiner, N., Goodman, J. and Kimmel, P. (2002) The HIV Associated Renal Diseases, Current Insight into Pathogenesis and Treatment. Kidney International, 63, 1618-1631. http://dx.doi.org/10.1046/j.1523-1755.2003.00901.x
[63]
Szczech, L., Hoover, D., Feldman, J., Cohen, M., Gange, S. and Gooze, L. (2004) Association between Renal Disease and Outcomes among HIV-infected Women Receiving or Not Receiving Antiretroviral Therapy. Clinical Infectious Diseases, 39, 1199-1206. http://dx.doi.org/10.1086/424013
[64]
Winston, A., Lehane, D., Gray, R. and Daskal, Y. (1979) The Effect of Diuretic Pre-Treatment on Clinical, Morphological and Ultrastructural Cis-Platinum Induced Nephrotoxicity. International Journal of Radiation Oncology, Biology, Physics, 5, 1393-1399. http://dx.doi.org/10.1016/0360-3016(79)90677-1
[65]
Okafor, U.H., Unuigbe, E.I. and Wokoma, F.S. (2011) Spectrum of Clinical Presentations in Human Immunodeficiency Virus (HIV) Infected Patients with Renal Disease. African Journal of Infectious Diseases, 5, 28-32.
http://dx.doi.org/10.4314/ajid.v5i2.66509
[66]
Agbaji, O., Onu, A., Agaba, P., Muazu, M., Falang, K. and Idoko, J. (2011) Predictors of Impaired Renal Function among HIV Infected Patients Commencing Highly Active Antiretroviral Therapy in Jos, Nigeria. Nigerian Medical Journal, 52, 182-185. http://dx.doi.org/10.4103/0300-1652.86133
[67]
Crum-Cianflone, N., Ganesan, A., Teneza-Mora, N., Riddle, M., Barahona, M.S. and Brodine, S. (2010) Prevalence and Factors Associated with Renal Dysfunction among HIV-Infected Patients. AIDS Patient Care and STDs, 24, 353-360. http://dx.doi.org/10.1089/apc.2009.0326
[68]
Mocroft, A., Kirk, O., Gatell, J., Reiss, P., Gargalianos, P., Zilmer, K., Beniowski, M., Viard, J.-P., Staszewski, S. and Lundgren, J.D. (2007) Chronic Renal Failure among HIV-1-Infected Patients. AIDS, 21, 1119-1127.
http://dx.doi.org/10.1097/QAD.0b013e3280f774ee
[69]
Mocroft, A., Kirk, O., Reiss, P., De Wit, S., Sedlacek, D., Beniowski, M., Gatell, J., Phillips, A.N., Ledergerber, B. and Lundgren, J.D. (2010) Estimated Glomerular Filtration Rate, Chronic Kidney Disease and Antiretroviral Drug Use in HIV-Positive Patients. AIDS, 24, 1667-1678. http://dx.doi.org/10.1097/QAD.0b013e328339fe53
[70]
Odongo, P., Wanyama, R., Obol, J.H., Apiyo, P. and Byakika-Kibwika, P. (2015) Impaired Renal Function and Associated Risk Factors in Newly Diagnosed HIV-Infected Adults in Gulu Hospital, Northern Uganda. BMC Nephrology, 16, 43. http://dx.doi.org/10.1186/s12882-015-0035-3
[71]
Mulenga, L.B., Kruse, G., Lakhi, S., Cantrell, R.A., Reid, S.E., Zulu, I., Stringer, E.M., Krishnasami, Z., Mwinga, A., Saag, M.S., et al. (2008) Baseline Renal Insufficiency and Risk of death among HIV-Infected Adults on Antiretroviral Therapy in Lusaka, Zambia. AIDS, 22, 1821-1827. http://dx.doi.org/10.1097/QAD.0b013e328307a051
[72]
Onodugo, O.D., Chukwuka, C., Onyedum, C., Ejim, E., Mbah, A., Nkwo, P., Ugwu, G., Ukoma, U., Okafor, C., Anyene, C. and Nwabueze, E. (2014) Baseline Renal Function among Antiretroviral Therapy-Naive, HIV-Infected Patients in Southeast Nigeria. Journal of the International Association of Providers of AIDS Care (JIAPAC), 13, 476-480.
http://dx.doi.org/10.1177/2325957413488169
[73]
Winston, J., Klotman, M. and Klotman, P. (1999) HIV Associated Nephropathy Is a Late, Not Early, Manifestation of HIV-1 Infection. Kidney International, 55, 1036-1040. http://dx.doi.org/10.1046/j.1523-1755.1999.0550031036.x
[74]
Winston, J., Bruggeman, L. and Ross, M. (2001) Nephropathy and Establishment of a Renal Reservoir of HIV Type 1 during Primary Infection. The New England Journal of Medicine, 344, 1979-1984.
http://dx.doi.org/10.1056/NEJM200106283442604
[75]
Krawczyk, C., Holmberg, S., Moorman, A., Gardner, L. and McGwinjnr, G. (2004) Factors Associated with Chronic Renal Failure in HIV Infected Ambulatory Patients. AIDS, 18, 2171-2178.
http://dx.doi.org/10.1097/00002030-200411050-00009
[76]
Wang, Y., Feng, X. and Bao, S. (2005) Depletion of CD4+ T Cells Aggravate Glomerular and Interstitial Injury in Murine Adriamycin Nephropathy. Kidney International, 59, 975-984.
http://dx.doi.org/10.1046/j.1523-1755.2001.059003975.x
[77]
Mungreiphy, N.K., Kapoor, S. and Sinha, R. (2011) Association between BMI, Blood Pressure, and Age: Study among Tangkhul Naga Tribal Males of Northeast India. Journal of Anthropology, 127, 119-125.
http://dx.doi.org/10.1155/2011/748147
