RENAL AND HEPATIC DYSFUNCTION IN HIV AND MALARIA CO-INFECTION: ACOMPARATIVE ANALYSIS OF BIOMARKERS AND THEIR DIAGNOSTIC ACCURACY
Keywords:
Renal function tests, liver function markers, diagnostic accuracy, biochemical markers,, dysfunctions, Youden indexAbstract
Background: The aim of the study was to find the diagnostic and clinical meaning of renal and hepatic biochemical indicators in HIV-1-infected children with and without Plasmodium falciparum malaria infection in Western Kenya.
Methods: A cross-sectional study was carried out. Renal markers (creatinine, urea) and hepatic (ALT, AST, GGT, ALP, LDH, total and direct bilirubin, total protein, albumin and globulins) enzymes in the serum and plasma were measured. Diagnostic performance was rated with the help of ROC analysis and Youden index in order to separate the cases co-infected with HIV and HIV-only
controls.
Results: Co-infection of malaria-HIV resulted in a much higher serum
creatinine level (93.0 umol/L, median) and urea level (4.9 mmol/L, median) as compared to non-co-infected HIV children (creatinine: 80.0 umol/L, p = 0.001; urea: 3.7 mmol/L, p < 0.0001). Both groups were similar in terms of hypercreatinemia (75.4% vs. 71.0%, p = 0.564) and more severely infected children had hyperuremia (26.1% vs. 1.4% p < 0.0001). Hepatic parameters, such as ALT, AST, GGT, bilirubin ratio, total protein, albumin, and globulins, were highly increased in the co-infected group and the rates of abnormal values were higher. It was found that co-infection and hyperbilirubinemia were strongly correlated with an odds ratio of 15.8 (95% CI: 5.18-48.12, p < 0.0001). There were no significant differences in ALP and LDH. Diagnostic analysis revealed average ROC-AUC total bilirubin (0.7-0.8), poor performance in a number of markers (0.6-0.7) and failed performance in creatinine, ALP, and LDH (0.5-0.6). However, LDH was shown to be of high diagnostic utility (Youden, index: 82.2, sensitivity: 91.2, specificity: 91.0).
Conclusions: P. falciparum -HIV co-infection in children is related to significant renal and hepatic biochemical abnormalities. Despite the low diagnostic value of the majority of markers, LDH was the most accurate one. The close correlation with hyperbilirubinemia highlights the clinical benefit of coinfection and promotes the application of combined diagnostic strategies to impacted pediatric patients.
