肾脏疾病在人类免疫缺陷病毒(HIV)感染者中很常见。然而,在亚洲人群中,有关肾功能不全的发病率和危险因素的信息有限.
我们使用了来自TREATAsiaHIV观察数据库的数据。如果患者在2003年期间或之后开始抗逆转录病毒治疗,在抗逆转录病毒治疗开始时(基线)进行血清肌酐测量,且至少2次随访肌酐测量间隔≥3个月.排除基线估计肾小球滤过率(eGFR)≤60mL/min/1.73m2的患者。慢性肾脏病定义为2个连续eGFR值≤60mL/min/1.73m2,间隔≥3个月。使用广义估计方程来识别与eGFR变化相关的因素。根据研究地点调整的竞争风险回归,年龄和性别,和累积发病率图用于评估与慢性肾脏病(CKD)相关的因素。
在符合此分析条件的2547名患者中,替诺福韦在基线时使用703(27.6%)。替诺福韦使用,高基线eGFR,晚期HIV疾病阶段,低的最低点CD4与随访期间的eGFR降低相关。慢性肾脏病的发生率为3.4/1000患者/年。与CKD相关的因素是替诺福韦的使用,老年,低基线eGFR,低最低点CD4和蛋白酶抑制剂的使用。
迫切需要加强亚洲高危人群的肾脏监测和管理能力,并改善获得肾毒性较低的抗逆转录病毒药物的机会。
Renal disease is common among people living with human immunodeficiency virus (HIV). However, there is limited information on the incidence and risk factors associated with renal dysfunction among this population in Asia.
We used data from the TREAT Asia HIV Observational Database. Patients were included if they started antiretroviral therapy during or after 2003, had a serum creatinine measurement at antiretroviral therapy initiation (baseline), and had at least 2 follow-up creatinine measurements taken ≥3 months apart. Patients with a baseline estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 were excluded. Chronic kidney disease was defined as 2 consecutive eGFR values ≤60 mL/min/1.73 m2 taken ≥3 months apart. Generalized estimating equations were used to identify factors associated with eGFR change. Competing risk regression adjusted for study site, age and sex, and cumulative incidence plots were used to evaluate factors associated with chronic kidney disease (CKD).
Of 2547 patients eligible for this analysis, tenofovir was being used by 703 (27.6%) at baseline. Tenofovir use, high baseline eGFR, advanced HIV disease stage, and low nadir CD4 were associated with a decrease in eGFR during follow-up. Chronic kidney disease occurred at a rate of 3.4 per 1000 patient/years. Factors associated with CKD were tenofovir use, old age, low baseline eGFR, low nadir CD4, and protease inhibitor use.
There is an urgent need to enhance renal monitoring and management capacity among at-risk groups in Asia and improve access to less nephrotoxic antiretrovirals.