Lucas Gregory M, Eustace Joseph A, Sozio Stephen, Mentari Evelyn K, Appiah Kofi A, Moore Richard D
Johns Hopkins University, Baltimore and the Good Samaritan Hospital, Baltimore, Maryland, USA.
AIDS. 2004 Feb 20;18(3):541-6. doi: 10.1097/00002030-200402200-00022.
to assess temporal changes in the incidence of human immunodeficiency virus-1-associated nephropathy (HIVAN), and the association with use of highly active antiretroviral therapy (HAART).
HIVAN incidence and risk factors were assessed in 3976 HIV-1-infected individuals followed in clinical cohort in Baltimore, Maryland, USA from 1989 to 2001. The incidence of HIVAN, defined by biopsy or a conservative uniformly applied clinical coding protocol, was expressed in terms of person-years, and Poisson regression was used for multivariate analysis.
Ninety-four patients developed HIVAN over the course of the study for an incidence of 8.0 per 1000 person-years [95% confidence interval (CI), 6.5 to 9.8]. African American race and advanced immunosuppression were strongly associated with HIVAN risk. HIVAN incidence declined significantly in 1998-2001 compared with 1995-1997. Among patients with a prior diagnosis of AIDS, HIVAN incidence was 26.4, 14.4, and 6.8 per 1000 person-years in patients not receiving antiretroviral therapy, treated with nucleoside analogue therapy only, or treated with HAART, respectively (P < 0.001 for trend). In multivariate analysis, HIVAN risk was reduced 60% (95% CI, -30 to -80%) by use of HAART, and no patient developed HIVAN when HAART had been initiated prior to the development of AIDS.
HAART was associated with a substantial reduction in HIVAN incidence. Additional follow-up will be needed to determine if renal damage in susceptible individuals is halted or merely slowed by HAART, particularly when control of viremia is incomplete or intermittent.
评估人类免疫缺陷病毒1型相关性肾病（HIVAN）发病率的时间变化，以及与高效抗逆转录病毒治疗（HAART）使用之间的关联。
对1989年至2001年在美国马里兰州巴尔的摩市临床队列中随访的3976例感染人类免疫缺陷病毒1型的个体进行HIVAN发病率及危险因素评估。通过活检或统一应用的保守临床编码方案定义的HIVAN发病率以人年表示，并采用泊松回归进行多变量分析。
在研究过程中，94例患者发生了HIVAN，发病率为每1000人年8.0例[95%置信区间（CI），6.5至9.8]。非裔美国人种族和严重免疫抑制与HIVAN风险密切相关。与1995 - 1997年相比，1998 - 2001年HIVAN发病率显著下降。在先前诊断为艾滋病的患者中，未接受抗逆转录病毒治疗、仅接受核苷类似物治疗或接受HAART治疗的患者，HIVAN发病率分别为每1000人年26.4例、14.4例和6.8例（趋势P<0.001）。在多变量分析中，使用HAART可使HIVAN风险降低60%（95%CI，-30至-80%），并且在艾滋病发生之前开始使用HAART时，没有患者发生HIVAN。
HAART与HIVAN发病率的大幅降低相关。需要进一步随访以确定HAART是否能阻止或仅减缓易感个体的肾脏损害，特别是在病毒血症控制不完全或间歇性的情况下。
