Take extra-care of kidneys when living with HIV

The people living with HIV (PLHIV), particularly those who are on the antiretroviral therapy (ART) consisting of tenofovir drug, should take extra-care of their kidneys. This was another key learning for me personally at the recently concluded Chennai ART Symposium (CART 2011). CART 2011 was organized in Chennai, India (8-9 January 2011) by Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), in collaboration with Centre for AIDS Research (CFAR), Brown University, National Institute of Health (NIH), University of California (San Diego), Karolinska Institute, and HIV Medicine Association of India (HIVMAI).

One of the game-changers in HIV responses globally has been the roll out of ART. However the level to which care providers and communities understand a range of associated co-morbidities and co-infections needs more push than ever before.

Renal (kidney-related) toxicities and HIV was another key concern raised at CART 2011 by Dr Karen T Tashima, Associate Professor of Medicine, Alpert Medical School of Brown University.

Speaking on the key risk factors that can exacerbate renal toxicities associated with HIV, Dr Tashima listed diabetes, high blood pressure (BP), kidney stones, inflammation, allergic reactions to medications (example antibiotics), overuse of painkillers (like NSAIDS), drug abuse, use of creatinine or testosterone among others – are the prime reasons that can up the risk of kidney-related health issues among PLHIV.

It might be relevant to step back a little and have another look at the HIV affected communities in terms of prevalent diabetes incidence, tuberculosis (TB) incidence, age-related issues, high BP or allergies. For instance, country like India, is home to highest levels of diabetes in the world – cited as the ‘diabetes capital’ globally – and is also home to highest number of people with TB, a significant number of people living with HIV (PLHIV), and of those living with other conditions listed above as risk factors for renal toxicities. It may not be surprising to see alarming levels of co-infections or co-morbidities among PLHIV – including those dealing with renal issues.

What can national AIDS programmes do to prevent renal toxicities among PLHIV particularly those who are on ART with tenofovir as one of the drugs? Dr Tashima suggests that renal functions (kidney functions) should be evaluated in all people living with HIV (PLHIV) at the baseline (when they enrol into the programme) and then regularly reassessed one to two times per year in PLHIV on ART regimen consisting of tenofovir (this is as per the US Department of Health and Human Services (DHHS) guidelines), said Dr Tashima.

I don’t buy the argument that weak health systems cannot deliver this integrated and holistic treatment and care for all PLHIV. Look at the cost of and the high level to which existing health systems are over-burdened if not crumbling with preventable or avoidable conditions or co-morbidities. Taking good care of kidneys and other co-infections and co-morbidities will probably yield much higher outcomes in terms of public health, and health financing.

Dr Tashima adds another merit to evaluating renal functions regularly among PLHIV particularly those on ART with tenofovir as one of the drugs. Dr Tashima said that renal or kidney dysfunction can be improved among PLHIV by starting HAART (highly active ART), as per the results of studies like SMART and DART.

Hope India’s National AIDS Control Organization (NACO) and other public and private health agencies are listening – and synergise so as to deliver holistic and comprehensive healthcare to all – including PLHIV.

Bobby Ramakant - CNS 

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