Winston A, Amin J, Mallon Pwg, Marriott D, Carr A, Cooper D A, Emery S
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
HIV Med. 2006 Mar;7(2):105-11. doi: 10.1111/j.1468-1293.2006.00349.x.
Tenofovir disoproxil fumarate (Tenofovir DF, TDF), the first nucleotide reverse transcriptase inhibitor approved for the treatment of HIV disease, has been associated with renal dysfunction in isolated cases. The aim of this study was to assess changes in renal parameters in individuals receiving TDF- and non-TDF-containing highly active antiretroviral therapy (HAART).
All individuals on HAART attending our clinic were included in the analysis. Time-weighted changes in serum creatinine, calculated creatinine clearance (CCrCl) and anion-gap were assessed for individuals on TDF- and non-TDF HAART.
Of 948 individuals on HAART, 290 (31%) and 618 (65%) were on TDF- and non-TDF HAART, with 40 (4%) having ceased TDF HAART. Baseline values for serum creatinine, CCrCl and anion-gap were similar for those on TDF- and non-TDF HAART. In a multivariate analysis, statistically significant differences were observed in time-weighted change from baseline in anion-gap and CCrCl between individuals on TDF- and non-TDF HAART [mean difference in change between groups: anion-gap 0.78 mmol/L (standard error, 0.19) and CCrCl-6.80 (standard error 2.2); P = 0.005 and P = 0.032, respectively] after adjusting for baseline anion-gap and CCrCl, respectively. Two cases of TDF-associated renal failure were observed.
Overt renal failure with TDF HAART is rare. However, subtle but statistically significant changes in anion-gap and CCrCl were observed which were associated with TDF HAART. These parameters may be of use in monitoring individuals on HAART.
替诺福韦酯（TDF）是首个被批准用于治疗HIV疾病的核苷酸类逆转录酶抑制剂，个别病例报告显示其与肾功能障碍有关。本研究旨在评估接受含TDF和不含TDF的高效抗逆转录病毒治疗（HAART）的个体的肾脏参数变化。
本分析纳入了所有在我们诊所接受HAART治疗的个体。对接受含TDF和不含TDF HAART治疗的个体，评估血清肌酐、计算得出的肌酐清除率（CCrCl）和阴离子间隙的时间加权变化。
在948例接受HAART治疗的个体中，290例（31%）接受含TDF的HAART治疗，618例（65%）接受不含TDF的HAART治疗，40例（4%）已停止TDF HAART治疗。接受含TDF和不含TDF HAART治疗者的血清肌酐、CCrCl和阴离子间隙的基线值相似。在多变量分析中，在分别调整基线阴离子间隙和CCrCl后，观察到接受含TDF和不含TDF HAART治疗的个体之间，阴离子间隙和CCrCl从基线开始的时间加权变化存在统计学显著差异[两组变化均值差异：阴离子间隙为0.78 mmol/L（标准误，0.19），CCrCl为-6.80（标准误2.2）；P分别为0.005和0.032]。观察到2例与TDF相关的肾衰竭病例。
TDF HAART治疗导致的明显肾衰竭很少见。然而，观察到与TDF HAART治疗相关的阴离子间隙和CCrCl有细微但具有统计学意义的变化。这些参数可能有助于监测接受HAART治疗的个体。
