Antiretroviral treatments (ARVs) are a lifeline for those with HIV but they can put a significant strain on the kidneys if not managed properly. Think of your kidneys as the diligent backstage crew, constantly filtering out waste and toxins. Therefore, when ARVs add to their workload, the kidneys can start to falter.
The journey with HIV
HIV ambassador Zonwabele Tshayana from Centurion, Gauteng, who has been living with HIV for more than 20 years and has been on ARVs for 15 years, shares some lessons he has learned.
He says he made sure to reduce alcohol intake, reduce sugar consumption, and only drinks energy drinks when driving long distances.
Tshayana explains that in 2022, he was informed that his kidneys weren’t functioning well. He attributes this to not adhering properly to his hypertensive treatment.
“I get tested every six months, and among the things checked are liver and kidney function, but the most crucial one is the kidney function test.”
Zonwabele Tshayana
Tshayana adds that conducting his own research and reading treatment leaflets has been crucial for his survival. He takes walks and drinks a lot of water, however, he admits that one thing he struggles with is to quit smoking.
“I have quit smoking and relapsed several times; it’s a chain of bad habits. But I know that for my health, I should quit for good.”
Who is at risk of kidney disease?
Dr Mxolisi Xulu, based at Kabokweni’s Themba Hospital in Mpumalanga, identifies people who are diabetic, hypertensive, and obese as being at risk of renal failure.
“Diabetes itself can have an effect on the kidneys, so people living with both HIV and diabetes are at higher risk in that way.”
Dr Mxolisi Xulu
He adds, “Some HIV medicines can affect the kidneys.”
Xulu explains that uncontrolled high blood pressure is another health condition that leads to renal failure. When blood vessels become damaged, the kidneys don’t receive the oxygen and nutrients they need to work well.
Additionally, being overweight or obese may increase the risk for kidney disease in several different ways. Extra weight forces the kidneys to work harder and filter wastes above the normal level, he says.
The challenge is that these lifestyle diseases have a link with renal failure, both directly and indirectly, adds Xulu.
Monitoring kidney function
Dr Mthembeni Tebelele, the founder of Aphile Communications from Gqeberha in the Eastern Cape, says HIV, when left uncontrolled, can cause kidney disease known as HIV-associated nephropathy (HIVAN).
He emphasises the critical importance of monitoring kidney function, especially for people on medication combinations containing Tenofovir, as it slows the glomerular filtration rate (GFR).
According to Tebelele, GFR refers to the rate at which the kidneys clear certain salts (urea and creatinine) from the blood.
He highlights that monitoring kidney function is not only important as a potential side effect of some ARVs but also because the kidneys play a crucial role in the metabolism and excretion of drugs, not only those for HIV but for other diseases as well. People generally may have comorbidities such as diabetes, hypertension, etc.
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Lifestyle changes
Xulu explains that, like anyone living with a lifestyle disease, people need to be vigilant about their lifestyle because kidneys can be affected in the long run.
This includes monitoring what you eat, your water intake, exercising, and maintaining a well-balanced diet.
“People who use drugs are at risk of renal failure,” he says.
Xulu notes that cutting back on foods high in salt and sugar, as well as keeping all medical appointments, is the best move if you are living with HIV.
During medical visits, it is crucial to discuss with a healthcare provider the other medications you are taking, as well as any other lifestyle diseases you are living with, he says.
He points out that Tenofovir isn’t prescribed to individuals showing symptoms of renal failure. Even if those on Tenofovir exhibit signs of renal failure challenges, doctors typically adjust or reduce the treatment.
Therefore, it is important to visit a doctor for these check-ups. Every six months, HIV-positive individuals on ARVs undergo blood tests. If things don’t look good, they are advised to go every three months to monitor the treatment they are taking and kidney function tests, Xulu adds.
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