Possible biochemical markers of antiretroviral therapy (ART) failure in resource-constrained areas

Possible biochemical parameters that can distinguish clinically-failing people living with HIV/AIDS (PLWHA) from clinically-stable PLWHA on antiretroviral therapy (ART) were investigated in a north central location of Nigeria. The major aim of the study was to determine possible diagnostic biochemical markers that can be helpful in resource- and manpower-poor environments. Eighty (80) consenting persons living with HIV/AIDS who were on combined ART while attending a tertiary hospital in the North Central part of Nigeria were recruited for the study. Fifty (50) persons had clinically failing (CF) conditions while 32 were clinically stable (CS). Of the 50 CF cases 32 persons switched drugs while 18 did not in the course of their ART. In all, serum total bilirubin, total protein, total cholesterol, albumin, alkaline phosphatase (ALP), glucose, creatinine, urea and CD4 cell count were assayed. The values of these parameters in the CF and CS persons were statistically compared. The same parameters in the CF cases that switched drugs and those that maintained their drugs were also statistically compared with the corresponding values for the same parameters in the clinically stable persons. Alkaline phosphatase activity and total cholesterol levels and CD4 count in the CF cases were significantly (pd"0.05) different from the values for the CS persons. Only creatinine levels in CF persons that switched drugs differed significantly (pd"0.05) from the corresponding values in CF, persons that did not switch drugs even when there was no difference in creatinine values between the latter and the CS persons. CD4 count and total cholesterol levels may serve as useful indicators of potential clinically-failing and/or clinically stable cases of PLWHA on antiretroviral therapy. Creatinine levels on the other hand, may be useful in distinguishing PLWHA that switched drugs and those that did not. These parameters may serve as reliable rapid assessment tools for HIV/AIDS research and diagnosis in resources-poor areas.