Yahaya Ismail, Uthman Abdulrahman Olalekan, Uthman Muhammed Mubashir B
a) WMHTAC, Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK, b) Save The Youth Initiative, PO Box 3951, Kaduna North, Kaduna, Nigeria.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD007183. doi: 10.1002/14651858.CD007183.pub2.
Human immunodeficiency virus associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in Human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretrovirals, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated.
To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality.
We searched The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's specialised register, MEDLINE, EMBASE, AIDSearch, reference lists of articles and conference proceedings without language restrictions. We searched the international clinical trials registry platform search portal and also contacted individual researchers, research organisations and pharmaceutical companies that manufacture the drugs used for interventions.
Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN.
We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. We applied the inclusion criteria to identify four relevant ongoing studies, one is ongoing while the remaining two have completed recruitment and are yet to be published. The fourth study was suspended for an unknown reason.
No completed RCTs or quasi-RCTs were identified to be included in the study.
AUTHORS' CONCLUSIONS: There is no RCT-based evidence upon which to base guidelines for the treatment of HIVAN. However, steroids and ACEI appear to improve the kidney function of patients in the observational studies that were identified. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.
人类免疫缺陷病毒相关性肾病（HIVAN）是1型人类免疫缺陷病毒（HIV-1）血清型患者终末期肾病（ESKD）的最常见病因，且主要影响非洲裔患者。若不治疗，其会迅速进展为ESKD。治疗目标是减少HIV-1复制和/或减缓慢性肾病的进展。以下药物已用于治疗HIVAN：抗逆转录病毒药物、血管紧张素转换酶抑制剂（ACEi）、类固醇，以及最近使用的环孢素。尽管如此，每种干预措施的效果仍有待评估。
评估辅助治疗在HIVAN管理中的益处和危害及其对症状严重程度和全因死亡率的影响。
我们检索了Cochrane对照试验中心注册库（CENTRAL）、Cochrane肾脏组专业注册库、MEDLINE、EMBASE、AIDSearch、文章参考文献列表和会议论文集，无语言限制。我们检索了国际临床试验注册平台搜索门户，并联系了进行干预所用药物生产的个别研究人员、研究机构和制药公司。
用于治疗HIVAN的任何疗法的随机对照试验（RCT）和半随机对照试验。
我们独立筛选检索结果以查找相关研究，并在必要时获取全文。我们应用纳入标准确定了四项相关的正在进行的研究，一项正在进行，其余两项已完成招募但尚未发表。第四项研究因不明原因暂停。
未识别出可纳入该研究的已完成的RCT或半随机对照试验。
尚无基于RCT的证据可作为HIVAN治疗指南的依据。然而，在已识别的观察性研究中，类固醇和ACEI似乎可改善患者的肾功能。本综述强调需要高质量的RCT来研究治疗该群体的干预措施的效果。
