Following the rising prevalence of Human Immunodeficiency Virus-Associated Nephropathy (HIVAN) in Nigeria and the alarming financial strain it places on patients requiring dialysis, an expert has called on the Federal Government to subsidise dialysis costs and prioritise comprehensive care for individuals living with HIV.
HIVAN is a kidney disorder directly linked to HIV, which can lead to chronic kidney disease or even kidney failure if left untreated. These effects on the kidneys can be acute or chronic, potentially leading to kidney failure.
Chronic Kidney Diseases (CKD) such as HIVAN, are specific to HIV infection and while the prevalence varies geographically, reports show that Africa has the highest prevalence of CKD in people living with HIV infection.
The latest publication on Medscape titled ‘HIV-Associated Nephropathy and Other HIV-Related Renal Disorders’ by Moro Salifu and others reported a 38 per cent prevalence of HIV-associated nephropathy in Nigeria.
According to the report, the prevalence of End-Stage Kidney Disease (ESKD) in the HIV-positive population continues to rise with about two-fold to 20-fold greater risk of ESRD compared with the general population as well as significant racial disparity in the burden up to six times higher risk borne by individuals of African origin.
The researchers noted that although HIV-associated nephropathy has become less common since the introduction of potent antiretroviral therapy, the incidence remains substantial, and the trend is toward more severe cases and increased mortality risk.
ESKD is a progressive disorder, also known as End-Stage Renal Disease (ESRD), in the final or permanent stage of chronic kidney disease, where kidney function has declined to the point that the kidneys can no longer function on their own and may necessitate kidney transplantation or dialysis.
Despite the high prevalence of ESKD in Nigeria, reports have shown that only two per cent receive hemodialysis; the most widely available form of Renal Replacement Therapy (RRT) and this has been attributed to the prohibitive cost of dialysis treatment in Nigeria.
Statistics have shown that over 40 per cent of Nigerians live below the poverty line and while minimum wage remains paltry, the situation is worsened by the current economic uncertainties.
With limited access to affordable healthcare and a lack of robust government support for chronic kidney disease management, thousands of Nigerians are left grappling with the dual burden of battling life-threatening illnesses and unaffordable treatment costs.
This meagre income implies that a large proportion of ESKD patients will either not subscribe to dialysis or exhaust their earnings or savings and still not be able to sustain the treatment optimally.
Also, a dialysis report by researchers at Delta State University, Abraka revealed that only 3,000 patients received hemodialysis nationwide, and 80 per cent of these patients did not sustain treatment beyond three months, resulting in repeated hospitalisation of ESKD patients, poor quality of life, high morbidity, and premature deaths.
However, dialysis in Nigeria is costly for most patients. Costs can reach up to ₦150,000 per week, varying significantly between public and private healthcare facilities. Unfortunately, this high cost means many patients cannot sustain long-term treatment, leading to poor survival rates.
A professor of Medicine and Nephrologist at the College of Health Sciences (CHS), Bayero University Kano, Aliyu Abdu told The Guardian that while the exact prevalence is unclear, studies have revealed varying percentages depending on the population that was sampled.
He stressed that research in cities like Benin City, Jos, and Kano reported prevalence rates as high as 50 per cent, while Zaria reported 30 per cent. He said with advances in early detection and the widespread availability of antiretroviral therapy (ART), the current prevalence may be significantly lower.
Abdu explained that HIV can affect the kidneys in various ways, either directly by the virus or through co-infections and co-morbidities associated with the disease or as complications from certain medications used in its treatment.
“The kidney affectation is sometimes acute, which can resolve on its own or following treatment or can be chronic, which may lead to loss of kidney function and eventual need of kidney replacement therapy either in the form of dialysis or kidney transplant,” he said.
He mentioned risk factors such as low Cluster of Differentiation 4 (CD4) counts and uncontrolled viral loads as the primary risk factors for kidney disease in individuals living with HIV combined with other health conditions, increasing the likelihood of kidney complications.
Speaking on available treatment options for HIVAN, Abdu pointed out that dialysis and kidney transplantation are viable treatment options. However, he added that the success rate depends on several factors including pre-treatment preparation, existing co-morbidities, the severity of HIV at the time of initiating therapy and the ability to afford optimal therapy.
He said that chances of survival are usually slim due to the high cost of dialysis in Nigeria. He explained that not many patients survive for long due to the cost which is high in both public and private facilities.
He recommended government intervention at all levels to aid these patients by making the treatment available and affordable. He urged the government to assist by importing and distributing the consumables needed for such treatment at various hospitals.
“Philanthropic individuals and non-governmental organisations should assist by sponsoring treatment of these patients, as well supporting the health facilities with the necessary materials needed for the treatment,” he added.
