Liver and Renal Profiles in Kala-azar, HIV and Kala-azar patients co-infected with HIV in Gedarif and Sinnar States. Sudan.

Abstract

Background: Visceral Leishmaniasis (VL) presents a major health problem in several states in Sudan. VL/HIV co-infection is an emerging health problem which has been reported to be associated with renal and liver dysfunction. Design: A descriptive study and cross sectional studies also were performed. Setting: The study was conducted at Tabarak-Allah Rural Hospital Gedarif state and Al- Azaza Centre, Sinnar State. Objectives: General objective: To study the prevalence of VL/HIV co-infection in the Sudan Specific objective: To determine the liver and renal profiles in VL, HIV and VL/HIV co-infected patients. Material and methods: A total of 99 VL parasitologicaly confirmed cases in Tabarak-Allah Rural Hospital (Gedarif state, Eastern Sudan) and Al- Azaza Centre (Sinnar State) and. There were 57(57.6%) males and 42(42.4%) females, their ages ranged from 2-75 years (mean of ages was 16 years),30 HIV seropositive individuals from Al Gadarif Teaching Hospital were studied, 23 (76.7%) of them were males, and 7 (23.3%) were females. Their age ranged between 30 and 54 years (mean of age was 40 years). All serum samples from VL samples were analyzed for renal and liver profiles using chemistry analyzer and were also screened for HIV by third generation ELISA kits. The 30 HIV seropositive samples were analyzed for liver and renal profiles and for CD4 cell count by flowcytometry. Results: Of the 99 VL confirmed cases jaundice was detected in Nine (9.1%), elevated AST activity in 85(85.9%), elevated ALT in 19(19.2%), VII elevated ALP in 55(556%) , low albumin level in 78(78.8%), hyperprotienamia in 40 (40.4%), azotamia in 7 (7.3%), hypocalcaemia in 48 (48.5%), hyponatraemia in 89(899%), hypokalamia in 29(29.3%) and hyperkalaemia in 11(11.1%). Two (2.4%) patients had renal failure. Seven (7.1%) of the 99 confirmed VL patients were HIV co-infected. One (14.3%) of those 7 HIV/ VL co-infected cases had elevated ALT, 7(100%) had elevated AST, 6(85.7%) had elevated ALP activity, 2(28.6%) had hyperprotienamia, 5(71.4%) had hypoalbuminaemia, 3(42.9%) had hypocalcaemia, 7(100%) had hyponatraemia, 2(28.6%) had hypokalamia and 1(14.3%) had hyperkalaemia. Of the 30 HIV seropositive individuals, 3(10%) were jaundiced,12(40%) had elevated ALT,11(36.7%) had elevated AST , 11(36.7%) had elevated ALP, 6(20%) had hyperprotiemaemia,3(10%) had hyperprotienamia, 19(63.3%) had hypoalbuminaemia, 3(10%) had Azotamia, 16(60%) had hyponatraemia, 2(6.7%) had hyperkalaemia, 10(33.3%) had hypokalamia, 13(43.3%) had hyperuricaemia , 1(3.3%) had hypouricaemia ,16(53.3%) had hypocalcaemia and one (3.3%) had renal failure. The comparison of liver profile between confirmed VL and VL/coinfected cases showed significant differences in in ALT , ALP ,AST , T.Protien and Albumin Levels ( P.Value < 0.05) but there was no significant difference in T.Bilirubin and D.Bilirubin levels ( P.Value > 0.05). In the renal profile creatinine and sodium levels, were also significantly different between the two groups (P.Value < 0.05). However, there was no significant difference in urea, calcium and potassium levels (P.value > 0.05). VIII Conclusion and Recommendation: In view of the results of the present study it is concluded that VL and VL/HIV co-infection can be associated with impairment in renal and liver functions; .The prevalence of VL /HIV co-infection is increasing in Sudan. Accordingly, it can be recommended that renal and liver profiles should be determined before treatment in all VL cases that show clinical features of renal or liver dysfunction. Urine analysis is recommended to be a routine test in VL as an indicator for any abnormality in renal function. Due to the limited number of VL/HIV coinfected cases in the present study further studies involving larger sample size are required.