Guaraldi Giovanni, Roverato Alberto, Giovanardi Chiara, Ravera Federica, Squillace Nicola, Orlando Gabriella, Cappelli Gianni, Esposito Roberto, Palella Frank
Dipartimento di Medicine e Specialità Mediche, University of Modena and Reggio Emilia, Modena, Italy.
J Antimicrob Chemother. 2009 Feb;63(2):374-9. doi: 10.1093/jac/dkn499. Epub 2008 Dec 17.
The aim of our study was to assess the impact of plasma HIV-1 RNA level [viral load (VL)] variation and tenofovir exposure on kidney functions by analysing changes in calculated glomerular filtration rates (GFRs) over a 48 week period in patients with mild renal impairment.
A prospective observational study that included data from all consecutive HIV-infected patients who attended a metabolic clinic was conducted. Included were adult, antiretroviral (ARV)-experienced, tenofovir-naive patients, whose kidney functions were evaluated by calculated GFR using the simplified Modification of Diet in Renal Disease study equation (MDRD). Tenofovir-exposed patients were patients who initiated tenofovir therapy at baseline and tenofovir-unexposed patients were patients whose ARV therapy did not include tenofovir. Participants were stratified into three sub-groups according to the plasma HIV-1 RNA (VL) changes observed: sub-groups 1, 2 and 3 were patients with stable VL < or =50 copies/mL, >0.5 log(10) VL increases and >0.5 VL log(10) decreases, respectively.
Ninety-nine patients were enrolled and included in the analysis. Within the tenofovir-unexposed group, GFRs remained stable (ANOVA, P = 0.94) over the follow-up period. Within the tenofovir-exposed group, mean GFR changes varied significantly by sub-group (ANOVA, P < 0.01). In particular, GFR changes in sub-group 3 (+8.4 +/- 12.4 mL/min) were different from those seen in sub-group 1 (-1.0 +/- 8.8 mL/min) (P < 0.05) and sub-group 2 (-4.6 +/- 8.8 mL/min) (P < 0.01).
Observed improvements in GFR that occurred as a consequence of highly active ARV therapy-induced viral suppression may have more than offset any potential negative effects of tenofovir on renal function.
我们研究的目的是通过分析轻度肾功能损害患者在48周内计算肾小球滤过率（GFR）的变化，评估血浆HIV-1 RNA水平[病毒载量（VL）]变化和替诺福韦暴露对肾功能的影响。
进行了一项前瞻性观察性研究，纳入了代谢门诊所有连续就诊的HIV感染患者的数据。纳入对象为成年、有抗逆转录病毒（ARV）治疗经验、未使用过替诺福韦的患者，其肾功能通过使用简化的肾脏疾病饮食改良研究方程（MDRD）计算GFR进行评估。接受替诺福韦治疗的患者是在基线时开始使用替诺福韦治疗的患者；未接受替诺福韦治疗的患者是其ARV治疗方案中不包括替诺福韦的患者。根据观察到的血浆HIV-1 RNA（VL）变化，将参与者分为三个亚组：亚组1、2和3分别为VL稳定<或=50拷贝/mL、VL增加>0.5 log(10)和VL降低>0.5 log(10)的患者。
99名患者被纳入分析。在未接受替诺福韦治疗的组中，随访期间GFR保持稳定（方差分析，P = 0.94）。在接受替诺福韦治疗的组中，亚组间平均GFR变化差异显著（方差分析，P < 0.01）。特别是，亚组3的GFR变化（+8.4 +/- 12.4 mL/分钟）与亚组1（-1.0 +/- 8.8 mL/分钟）（P < 0.05）和亚组2（-4.6 +/- 8.8 mL/分钟）（P < 0.01）不同。
高效抗逆转录病毒治疗诱导的病毒抑制导致的GFR改善可能抵消了替诺福韦对肾功能的任何潜在负面影响。
