■几例Fanconi综合征(FS),严重的肾毒性,已报道HIV患者接受含有替诺福韦的抗逆转录病毒治疗。对HIV患者替诺福韦相关FS的已发表文献进行了系统评价。
■PubMed和Embase被查询,以确定在2005年1月至2023年6月之间发表的英文文章,报告了成人HIV患者替诺福韦相关的FS。临床前研究,会议/海报摘要,评论和回应,审查文件被排除在外。
■在筛选的256篇文章中,57符合纳入标准。其中包括37例病例报告,11个案例系列,1个横断面研究,1例病例对照研究,4项队列研究,1个单臂开放标签临床试验,1次临床试验分析,和1项临床试验的汇总分析。
■在56个抽象信息的案例中,FS诊断时的中位年龄为50岁,51.8%是男性,替诺福韦使用的持续时间从6周到11年不等。在几乎一半的病例中,利托那韦被共同处方。在观察性和介入性研究中,FS发生率较低。许多研究报道了替诺福韦停药后FS症状的解决。所有FS发生在富马酸替诺福韦酯(TDF),除了一名患者服用替诺福韦艾拉酚胺(TAF)。
■持续监测肾脏和骨骼毒性的体征和症状对于接受替诺福韦治疗的HIV患者至关重要。
■接受替诺福韦治疗的HIV患者的FS发生率较低。同时使用利托那韦可能会增加FS的风险。就肾毒性而言,TAF可能比TDF更安全。
UNASSIGNED: Several cases of Fanconi syndrome (FS), a severe form of nephrotoxicity, have been reported in patients with HIV on tenofovir-containing antiretroviral therapy. A systematic
review of the published literature on tenofovir-related FS in patients with HIV was conducted.
UNASSIGNED: PubMed and Embase were queried to identify articles in English published between January 2005 and June 2023, reporting tenofovir-related FS in adults with HIV. Preclinical studies, conference/poster abstracts, commentaries and responses, and
review papers were excluded.
UNASSIGNED: Of the 256 articles screened, 57 met the inclusion criteria. These comprised 37 case reports, 11 case series, 1 cross-sectional study, 1 case-control study, 4 cohort studies, 1 single-arm open-label clinical trial, 1 sub-analysis of clinical trials, and 1 pooled analysis of clinical trials.
UNASSIGNED: Among 56 cases on which information was abstracted, median age at FS diagnosis was 50 years, 51.8% were men, and duration of tenofovir use ranged from 6 weeks to 11 years. Ritonavir was co-prescribed in almost half the cases. In observational and interventional studies, incidence of FS was low. Many studies reported resolution of FS symptoms after tenofovir discontinuation. All FS occurrences were identified in those on tenofovir disoproxil fumarate (TDF), except for one patient on tenofovir alafenamide (TAF).
UNASSIGNED: Continuous monitoring of signs and symptoms of renal and bone toxicity is essential for patients with HIV on tenofovir-containing therapy.
UNASSIGNED: Occurrence of FS is low in patients with HIV treated with tenofovir-based regimens. Concomitant use of ritonavir may increase risk of FS. TAF may be a safer alternative than TDF in terms of nephrotoxicity.