Longenecker Chris T, Scherzer Rebecca, Bacchetti Peter, Lewis Cora E, Grunfeld Carl, Shlipak Michael G
University of California, San Francisco, California 94121, USA.
AIDS. 2009 Jun 1;23(9):1089-96. doi: 10.1097/QAD.0b013e32832a3f24.
To evaluate the effect of HIV infection on longitudinal changes in kidney function and to identify independent predictors of kidney function changes in HIV-infected individuals.
A prospective cohort.
Cystatin C was measured at baseline and at the 5-year follow-up visit of the Study of Fat Redistribution and Metabolic Change in HIV infection in 554 HIV-infected participants and 230 controls. Control participants were obtained from the Coronary Artery Risk Development in Young Adults study. Glomerular filtration rate (eGFRcys) was estimated using the formula 76.7 x cysC(-1.19).
Compared with controls, HIV-infected participants had a greater proportion of clinical decliners (annual decrease in eGFRcys > 3 ml/min per 1.73 m2; 18 versus 13%, P = 0.002) and clinical improvers (annual increase in eGFRcys > 3 ml/min per 1.73 m2; 26 versus 6%, P < 0.0001). After multivariable adjustment, HIV infection was associated with higher odds of both clinical decline (odds ratio 2.2; 95% confidence interval 1.3, 3.9, P = 0.004) and clinical improvement (odds ratio 7.3; 95% confidence interval 3.9, 13.6, P < or = 0.0001). Among HIV-infected participants, a decrease in HIV viral load during follow-up was independently associated with clinical improvement; conversely, higher baseline and an increase in viral load during follow-up were associated with clinical decline. No individual antiretroviral drug or drug class appeared to be substantially associated with clinical decline or improvement.
Compared with controls, HIV-infected persons were more likely both to have clinical decline and clinical improvement in kidney function during 5 years of follow-up. The extent of viremic control had a strong association with longitudinal changes in kidney function.
评估HIV感染对肾功能纵向变化的影响，并确定HIV感染者肾功能变化的独立预测因素。
一项前瞻性队列研究。
在554名HIV感染者和230名对照者中，于HIV感染脂肪重新分布和代谢变化研究的基线及5年随访时检测胱抑素C。对照参与者来自青年成人冠状动脉风险发展研究。使用公式76.7×胱抑素C（-1.19）估算肾小球滤过率（eGFRcys）。
与对照者相比，HIV感染者中临床肾功能下降者（eGFRcys每年下降>3 ml/min/1.73 m²；分别为18%和13%，P = 0.002）和临床肾功能改善者（eGFRcys每年升高>3 ml/min/1.73 m²；分别为26%和6%，P < 0.0001）的比例更高。多变量调整后，HIV感染与临床肾功能下降（比值比2.2；95%置信区间1.3, 3.9，P = 0.004）和临床肾功能改善（比值比7.3；95%置信区间3.9, 13.6，P ≤ 0.0001）的较高几率相关。在HIV感染者中，随访期间HIV病毒载量下降与临床肾功能改善独立相关；相反，较高的基线水平及随访期间病毒载量增加与临床肾功能下降相关。没有单一抗逆转录病毒药物或药物类别似乎与临床肾功能下降或改善有实质性关联。
与对照者相比，HIV感染者在5年随访期间肾功能更有可能出现临床下降和临床改善。病毒血症控制程度与肾功能的纵向变化密切相关。
