PDF(Sci-hub)
Abstract：
OBJECTIVE: Emerging international guidelines for the prevention of mother-to-child transmission of HIV infection across sub-Saharan Africa call for the initiation of a triple-drug antiretroviral regimen containing tenofovir, a potentially nephrotoxic agent, in all HIV-infected pregnant women at the first antenatal clinic visit. While there are significant benefits to the rapid initiation of antiretroviral therapy (ART) in pregnancy, there are few data on the prevalence of pre-existing renal disease in HIV-infected pregnant women and in turn, the potential risks of this approach are not well understood.
METHODS: We analysed data on renal function in consecutive patients eligible for ART at a large primary healthcare clinic in Cape Town. All individuals were screened for renal dysfunction via serum creatinine and estimation of creatinine clearance via the Cockroft-Gault equation.
RESULTS: Over a 2-year period, 238 pregnant women, 1014 non-pregnant women and 609 men were screened to initiate ART. Pregnant women eligible were significantly younger, in earlier stages of HIV disease, had higher CD4 cell counts and lower HIV viral loads, than non-pregnant adults. The median serum creatinine in pregnant women (46 µmol/L) was significantly lower and the median creatinine clearance (163 ml/min/1.73 m(2) ) was significantly higher than other groups (P < 0.001 and P = 0.004, respectively). Fewer than 1% of pregnant women had moderate renal dysfunction before ART initiation, with no instances of severe dysfunction observed, compared to 7% moderate or severe renal dysfunction in non-pregnant women or men (P < 0.001).
CONCLUSIONS: Renal dysfunction in HIV-infected pregnant women is significantly less common than in other HIV-infected adults eligible for ART. The risks associated with initiating tenofovir immediately in pregnant women before reviewing serum creatinine results may be limited, and the benefits of rapid ART initiation in pregnancy may outweigh possible risks of nephrotoxicity.
METHODS: We analysed data on renal function in consecutive patients eligible for ART at a large primary healthcare clinic in Cape Town. All individuals were screened for renal dysfunction via serum creatinine and estimation of creatinine clearance via the Cockroft-Gault equation.
RESULTS: Over a 2-year period, 238 pregnant women, 1014 non-pregnant women and 609 men were screened to initiate ART. Pregnant women eligible were significantly younger, in earlier stages of HIV disease, had higher CD4 cell counts and lower HIV viral loads, than non-pregnant adults. The median serum creatinine in pregnant women (46 µmol/L) was significantly lower and the median creatinine clearance (163 ml/min/1.73 m(2) ) was significantly higher than other groups (P < 0.001 and P = 0.004, respectively). Fewer than 1% of pregnant women had moderate renal dysfunction before ART initiation, with no instances of severe dysfunction observed, compared to 7% moderate or severe renal dysfunction in non-pregnant women or men (P < 0.001).
CONCLUSIONS: Renal dysfunction in HIV-infected pregnant women is significantly less common than in other HIV-infected adults eligible for ART. The risks associated with initiating tenofovir immediately in pregnant women before reviewing serum creatinine results may be limited, and the benefits of rapid ART initiation in pregnancy may outweigh possible risks of nephrotoxicity.
摘要：
目的：撒哈拉以南非洲地区预防艾滋病毒母婴传播的新兴国际准则要求启动含有替诺福韦的三联抗逆转录病毒药物方案，一种潜在的肾毒性剂，所有感染艾滋病毒的孕妇在第一次产前诊所就诊。虽然在怀孕期间快速开始抗逆转录病毒治疗（ART）有显著的益处，关于感染艾滋病毒的孕妇中预先存在的肾脏疾病的患病率的数据很少，这种方法的潜在风险还没有得到很好的理解。
方法：我们分析了开普敦一家大型初级保健诊所连续接受ART的患者的肾功能数据。通过血清肌酐筛选所有个体的肾功能障碍，并通过Cockroft-Gault方程评估肌酐清除率。
结果：在2年内，238名孕妇对1014名非孕妇和609名男性进行了筛查，以启动ART。符合条件的孕妇明显年轻，在艾滋病毒疾病的早期阶段，有更高的CD4细胞计数和更低的HIV病毒载量，与非怀孕的成年人相比。孕妇的血清肌酐中位数（46µmol/L）明显低于其他组，肌酐清除率中位数（163ml/min/1.73m（2））明显高于其他组（分别为P<0.001和P=0.004）。在ART开始之前，不到1％的孕妇有中度肾功能不全，没有观察到严重功能障碍的情况，相比7%的中度或重度肾功能不全的非妊娠妇女或男性（P<0.001）。
结论：感染艾滋病毒的孕妇肾功能障碍明显低于其他有资格接受ART的感染艾滋病毒的成年人。在审查血清肌酐结果之前，立即在孕妇中启动替诺福韦相关的风险可能是有限的，妊娠期快速开始ART的益处可能超过肾毒性的可能风险。
方法：我们分析了开普敦一家大型初级保健诊所连续接受ART的患者的肾功能数据。通过血清肌酐筛选所有个体的肾功能障碍，并通过Cockroft-Gault方程评估肌酐清除率。
结果：在2年内，238名孕妇对1014名非孕妇和609名男性进行了筛查，以启动ART。符合条件的孕妇明显年轻，在艾滋病毒疾病的早期阶段，有更高的CD4细胞计数和更低的HIV病毒载量，与非怀孕的成年人相比。孕妇的血清肌酐中位数（46µmol/L）明显低于其他组，肌酐清除率中位数（163ml/min/1.73m（2））明显高于其他组（分别为P<0.001和P=0.004）。在ART开始之前，不到1％的孕妇有中度肾功能不全，没有观察到严重功能障碍的情况，相比7%的中度或重度肾功能不全的非妊娠妇女或男性（P<0.001）。
结论：感染艾滋病毒的孕妇肾功能障碍明显低于其他有资格接受ART的感染艾滋病毒的成年人。在审查血清肌酐结果之前，立即在孕妇中启动替诺福韦相关的风险可能是有限的，妊娠期快速开始ART的益处可能超过肾毒性的可能风险。
