含TDF的HAART方案对抗逆转录病毒药物初治成年HIV感染患者肾功能的影响研究

Effects of highly active antiretroviral therapy including tenofovir disoproxil fumarate on renal function among antiretroviral-nave HIV-infected adult patients

目的探索含替诺福韦酯(tenofovir disoproxil fumarate,TDF)的高效抗逆转录病毒疗法(highly active antiretroviral therapy,HAART)对抗逆转录病毒药物初治HIV感染患者肾功能的影响。方法本研究回顾性分析TDF治疗组和非TDF治疗组、依非韦伦(efavirenz,EFV)治疗组(即采用TDF+lamivudine(3TC)+EFV方案治疗)和克力芝(lopinavir/ritonavir,LPV/RTV)治疗组(即采用TDF+3TC+LPV/RTV方案治疗)在CD4细胞计数和内生肌酐清除率(rate of creatinine clearance,Cr Cl)上的差异。结果 TDF治疗组和非TDF治疗组患者的CD4细胞计数开始明显升高的时间分别为12周和48周。TDF治疗组患者在第24、48、60、72、84、96周时,Cr Cl比其基线时降低,差异具有统计学意义(均有P<0.05),而非TDF治疗组患者治疗后,Cr Cl未出现明显降低,无有统计学意义(均有P>0.05)。EFV治疗组和LPV/RTV治疗组患者均从第12周起,CD4细胞计数升高,差异均有统计学意义(均有P<0.05)。EFV治疗组患者和LPV/RTV治疗组患者的Cr Cl开始比其基线时降低的时间分别是72周和12周。结论在患者各项危险因素可控的情况下,推荐TDF+3TC+EFV为初治HIV患者的首选治疗方案。

Objective To explore the impact of tenofovir disoproxil fumarate（ TDF） included in high active antiretroviral treatment（ HAART） regimens on renal function and to compare the influence of two different TDF-containing HAART regimens. Methods A retrospective analysis was conducted to compare the CD4 cell count and rate of creatinine clearance（ Cr Cl） between the TDF-treated group and non-TDF-treated group as well as the EFV-treated group（ patients treated with TDF ＋ lamivudine（ 3TC） ＋ efavirenz（ EFV）） and LPV / RTV-treated group（ patients treated with TDF ＋3TC ＋ lopinavir / ritonavir（ LPV / RTV）） at baseline,12 weeks,24 weeks,36 weeks,48 weeks,60 weeks,72 weeks,84 weeks and 96 weeks post treatment initiation. Results CD4 cell count of the TDF-treated group and non-TDF-treated group increased significantly since 12 weeks and 48 weeks posttreatment respectively; Cr Cl had a statistically significant decrease in the TDF-treated group（ all P〈0. 05） but not in the non-TDF-treated group（ all P〈0. 05） in the 24 weeks,48 weeks,60 weeks,72 weeks,84 weeks and 96 weeks. CD4 cell count in the EFV-treated group and the LPV / RTV-treated group had a statistically significant increase since 12 weeks after treatment（ all P〈0. 05）; Cr Cl in the EFV-treated group had a significant decline since 72 weeks while in the LPV / RTV-treated group,it declined since 12 weeks. Conclusions When the risk factors are under control,the TDF ＋ 3TC ＋ EFV regimen is recommend as the optimal therap.