TDF+3TC+EFV和AZT+3TC+EFV方案治疗96周对初治HIV感染者肾功能的影响

Renal function of na?ve HIV patients after 96-week TDF+3TC+EFV or AZT+3TC+EFV treatment

目的探讨应用我国首选抗 HIV 治疗方案富马酸替诺福韦二吡呋酯(tenofovir disoproxil fumarate, TDF)+拉米夫定(lamivudine, 3TC)+依非韦伦(efavirenz, EFV)及备选方案齐多夫定(zidovudine, AZT)+3TC+EFV 对初治 HIV 感染者肾功能的影响。方法回顾性分析 2012 年 1 月—2014 年 5 月在上海市公共卫生临床中心艾滋病门诊使用上述 2 种方案抗病毒治疗并随访的初治 HIV 感染者 1045 例,其中应用 TDF+3TC+EFV 方案(TDF 组) 455 例,AZT+3TC+EFV 方案(AZT 组)590 例。收集患者人口学资料及临床治疗数据,分析 2 组治疗过程中肾功能指标变化情况。结果 TDF 组的基线、治疗 48 周、96 周估算肾小球滤过率(estimated glomerular fi ltration rate, eGFR)分别是 113.1 ml/(min·1.73 m^2),114.0 ml/(min·1.73 m^2)和 112.2 ml/(min·1.73 m^2);AZT 组的基线、治疗 48 周、96 周 eGFR 分别是 112.9 ml/(min·1.73 m^2),116.2 ml/(min·1.73 m^2)和 118.1 ml/(min·1.73 m^2)。与治疗前相比,TDF 组治疗 48 周 eGFR 水平有稍微升高,而在治疗 96 周时又回落至基线水平。而 AZT 组,治疗 48 周及 96 周的 eGFR 水平与基线 eGFR 水平相比均有升高。TDF 组中基线 eGFR < 90 ml/(min·1.73 m^2)者,治疗 48 周 eGFR 水平较基线有上升;AZT 组中基线 eGFR < 90 ml/(min·1.73 m^2)者治疗 48 周 eGFR 水平较基线有所升高。结论我国初治 HIV 感染者中应用 TDF+3TC+EFV 方案治疗者,开始治疗的 2 年内患者肾功能无明显减低;对于 60 ml/(min·1.73 m^2)< eGFR < 90 ml/(min·1.73 m2)的初治 HIV 感染者,TDF 组治疗后 eGFR 亦保持稳定。关于 TDF 组远期治疗后肾功能变化有待于进一步观察。

Objective To investigate the effects of tenofovir disoproxil fumarate (TDF)+lamivudine (3TC)+efavirenz (EFV) and the optional treatment of zidovudine (AZT)+3TC+EFV on renal function of naive HIV-infected patients. Methods A retrospective study was conducted among 1045 na?ve HIV-infected patients, who were treated with TDF+3TC+EFV regimen or AZT+3TC+EFV regimen and followed up from January 2012 to May 2014 in Shanghai Public Health Clinic Center. Among the involved 1045 patients, 455 cases received TDF+3TC+EFV regimen (TDF group) and 590 cases received AZT+3TC+EFV regimen (AZT group). The demographic and clinical treatment data of all patients were collected, the changes of renal function index in 2 groups were analyzed. Results At baseline, 48-week and 96-week treatment, the eGFR of TDF group were 113.1 ml/(min·1.73 m^2 ), 114.0 ml/(min·1.73 m^2 ) and 112.2 ml/(min·1.73 m^2 ), respectively. At baseline, 48-week and 96-week treatment, the eGFR of AZT group were 112.9 ml/(min·1.73 m^2 ), 116.2 ml/(min·1.73 m^2 ) and 118.1 ml/(min·1.73 m^2 ), respectively. Compared with baseline, the eGFR value of TDF group increased slightly at 48 weeks and fell back to the baseline level at 96 weeks. Compared with baseline, the eGFR value increased in AZT group at 48 and 96 weeks. For patients with baseline eGFR < 90 ml/(min·1.73 m^2 ) in TDF group, the eGFR increased at 48 weeks compared with baseline;For patients with baseline eGFR < 90 ml/(min·1.73 m^2 ) in AZT group, the eGFR increased at 48 weeks compared with baseline. Conclusions The regimen of TDF+3TC+EFV does not significantly reduce the renal function within the first two years of treatment among naive HIV-infected patients in China. For naive HIV-infected patients with 60 ml/(min·1.73 m^2 )< eGFR < 90 ml/(min·1.73 m^2 ), TDF regimen maintains stable eGFR after treatment. The changes of renal function in TDF group after long-term treatment need to be further observed.