郑州市城区初治HIV/AIDS患者使用替诺福韦二吡呋酯治疗3年肾功能变化

Renal function changes in patients with HIV/AIDS receiving tenofovir treatment for 3 years in Zhengzhou City

目的通过观察初治HIV/AIDS患者使用富马酸替诺福韦二吡呋酯(TDF)治疗3年的肾功能变化,探讨HIV/AIDS患者使用TDF发生慢性肾脏病(CKD)的危险因素。方法采用回顾性队列研究,选择2019年1月1日至2020年12月31日在河南省传染病医院感染与免疫门诊使用TDF的初治HIV/AIDS患者,分别收集患者治疗基线、治疗后6个月、12个月、18个月、24个月、30个月、36个月的血肌酐和尿蛋白,计算肾小球滤过率(eGFR),采用单因素和多因素分析患者发生CKD的危险因素。结果共纳入320例患者,男性296例(92.50%),女性24例(7.50%),年龄34(28,46)岁,合并高血压22人(6.88%),合并糖尿病24人(7.50%)。共发生CKD 31例(9.69%),其中CKD 1期23例(7.19%),CKD2期7例(2.19%),CKD5期1例(0.31%),均有白蛋白尿阳性表现,白蛋白尿分期为A2期29例,A3期2例。发生CKD时间为使用TDF24(12,30)个月,其中2例因为肾损伤更换为不含TDF方案。TDF治疗2年后发生CKD患者eGFR出现明显下降。多因素分析年龄≥50岁、合并糖尿病、联合使用LPV/r、基线CD4细胞<100个/μL和基线eGFR<120 mL/min·1.73 m^(2)是使用TDF患者发生CKD的危险因素。结论郑州城区门诊初治HIV/AIDS患者使用TDF 3年发生CKD以白蛋白尿阳性为主。年龄≥50岁、基线CD4细胞<100个/μL、基线eGFR<120 mL/min·1.73 m^(2)、合并糖尿病和联合使用LPV/r人群应加强肾功能监测,尤其使用TDF 2年以上。

Objective To observe the changes in renal function in patients with HIV/AIDS treated with tenofovir disoproxil fumarate(TDF)for 3 years.Methods This retrospective cohort study included first-line patients with HIV/AIDS treated with TDF at the Infectious Disease Hospital in Henan Province from January 1,2019,to December 31,2020.Data on baseline blood creatinine and urinary protein levels at 6,12,18,24,30,and 36 months post-treatment were collected to calculate the estimated glomerular filtration rate(eGFR).This study analyzed the risk factors for the occurrence of chronic kidney disease(CKD)in patients using both single-and multifactor analyses.Results A total of 320 patients were included,comprising 296 males(92.50%)and 24 females(7.50%).The median age was 34 years(28,46),with 22 individuals(6.88%)with hypertension and 24(7.50%)with diabetes.There were 31 patients(9.69%)with CKD,including 23 cases(7.19%)in stage 1,7 cases(2.19%)in stage 2,and 1 case(0.31%)in stage 5,all presenting with positive albuminuria.Albuminuria was classified as stage A2 in 29 cases and stage A3 in 2 cases.CKD occurred after a median TDF treatment duration of 24 months(12,30),with two patients switching to a TDF-free regimen owing to renal injury.Patients who developed CKD after 2 years of TDF treatment exhibited a significant decline in eGFR.Multifactorial analysis identified age≥50 years,diabetes comorbidity,concomitant use of lopinavir/ritonavir(LPV/r),baseline CD4 cell count<100 cells/μL,and baseline eGFR<120 mL/(min·1.73 m^(2))as risk factors for CKD in TDF users(P<0.05).Conclusions CKD,primarily characterized by positive albuminuria,was observed in outpatients with HIV/AIDS receiving TDF for 3 years in the Zhengzhou City.Individuals aged≥50 years,with baseline CD4 counts<100 cells/μL,baseline e GFR<120 m L/(min·1.73 m^(2)),a history of diabetes mellitus,or those using LPV/r should have their renal function monitored closely,especially when receiving TDF for more than 2 years.