HIV合并HBV感染者启动HAART后肾功能损害情况及影响因素分析

Prevalence of renal impairment and its influencing factors in HIV/HBV-coinfected patients after initiating highly active anti-retroviral treatment

目的了解人类免疫缺陷病毒(human immunodeficiency virus,HIV)合并乙型肝炎病毒(hepatitis B virus,HBV)感染者启动高效抗逆转录病毒治疗(highly active anti-retroviral treatment,HAART)后肾功能损害情况,并分析其影响因素。方法回顾性分析2010-01~2015-06广西启动HAART的3 395例HIV合并HBV感染者,采用Logistic回归模型分析启动治疗第12个月肾功能损害发生的影响因素。结果研究对象在启动HAART后第12个月的肾功能损害发生率为14.76%。服用含克力芝的一线治疗方案(AOR=4.19,95%CI=2.76~6.38)及启动治疗时WHO分期为3/4期(AOR=1.86,95%CI=1.49~2.33)是治疗后第12个月发生肾功能损害的危险因素。与启动治疗时CD4计数<200个/μL者相比,启动治疗时CD4计数为200~349个/μL(AOR=0.66,95%CI=0.50~0.85)、350~499个/μL(AOR=0.54,95%CI=0.34~0.84)、≥500个/μL者(AOR=0.36,95%CI=0.18~0.74)治疗后第12个月肾功能损害风险较低。结论HIV合并HBV感染者应尽早启动HAART,选择含替诺福韦的一线治疗方案可以有效降低治疗第12个月肾功能损害风险。

Objective To investigate the prevalence of renal impairment and its influencing factors in HIV(human immunodeficiency virus)/HBV(hepatitis B virus)-coinfected patients after initiating highly active anti-retroviral treatment(HAART).Methods Three thousand three hundred and ninety-five HIV/HBV-coinfected patients who had completed a 12-month initiated HAART from Guangxi from January 2010 to June 2015 were enrolled in this study.Logistic regression model was conducted to analyze the factors leading to renal impairment at the 12th month after the initiation of HAART.Results The incidence of renal impairment 12 months after initiation of antiviral therapy was 14.76%.The first-line treatment regimen containing lopinavir(AOR=4.19,95%CI=2.76~6.38)and the WHO stage of the initiation of treatment being 3/4 stages(AOR=1.86,95%CI=1.49~2.33)were the risk factors of renal impairment at the 12th month after treatment.Compared with those who started HAART at the level of CD4<200/μL,the patients who started HAART at the level of 200~349/μL(AOR=0.66,95%CI=0.50~0.85),350~499/μL(AOR=0.54,95%CI=0.34~0.84)or≥500/μL(AOR=0.36,95%CI=0.18~0.74)had lower risk of renal impairment after 12 months of HAART.Conclusion For HIV/HBV-coinfected patients,initiation of antiviral therapy as early as possible and selection of first-line treatment with tenofovir disoproxil fumarate(TDF)can effectively reduce the risk of renal impairment at the 12th month of treatment.