HIV, Immunology, and Infectious Disease Unit and Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.
J Acquir Immune Defic Syndr. 2010 Sep;55(1):78-81. doi: 10.1097/QAI.0b013e3181d05579.
Significant nephrotoxicity develops in 1%-2% of HIV-infected adults receiving tenofovir (TDF). This nephrotoxicity is said to resolve rapidly, but this assessment is based on short follow-up, very few patients and use of serum creatinine, an insensitive measure of renal function.
We determined the reversibility of TDF-related nephrotoxicity in 24 HIV-infected male outpatients who ceased TDF for renal impairment by retrospective assessment of estimated glomerular filtration rate (eGFR) using the Modified Diet in Renal Disease equation.
Median (interquartile range) eGFR pre-TDF was 74 (61-88) mL.min.1.73 m, fell to 51 (39-61) mL.min.1.73 m at TDF cessation and increased to 58 (48-70) mL.min.1.73 m a median 13 months after TDF cessation (most recent vs pre-TDF eGFR; P = 0.0008). Results were similar with the Cockcroft-Gault equation and after exclusion of patients who had shorter follow-up after TDF cessation. Only 10 (42%) patients reached their pre-TDF eGFR. Greater eGFR improvement was significantly associated with more rapid decline in eGFR on TDF therapy and in those who received TDF with a protease inhibitor, with a trend for shorter duration of TDF therapy.
In this population, TDF-related renal toxicity was not always fully reversible.
接受替诺福韦（TDF）治疗的 1%-2%HIV 感染成年人会出现显著的肾毒性。据称这种肾毒性会迅速缓解，但这种评估基于短期随访、患者数量非常少以及使用血清肌酐，这是一种不敏感的肾功能衡量指标。
我们通过使用改良肾脏病饮食方程（Modified Diet in Renal Disease equation）对 24 名因肾功能损害而停用 TDF 的 HIV 感染男性门诊患者的估算肾小球滤过率（estimated glomerular filtration rate，eGFR）进行回顾性评估，以确定 TDF 相关性肾毒性的可逆性。
TDF 停用前的中位数（四分位距）eGFR 为 74（61-88）mL.min.1.73 m，在 TDF 停用时降至 51（39-61）mL.min.1.73 m，在 TDF 停用后中位数 13 个月时增加至 58（48-70）mL.min.1.73 m（最近 vs 停用 TDF 前的 eGFR；P = 0.0008）。使用 Cockcroft-Gault 方程和排除 TDF 停药后随访时间较短的患者后，结果相似。只有 10 名（42%）患者达到了停用 TDF 前的 eGFR。eGFR 改善更大与 TDF 治疗时 eGFR 更快下降以及接受含蛋白酶抑制剂 TDF 治疗的患者显著相关，TDF 治疗持续时间较短也呈趋势。
在该人群中，TDF 相关性肾毒性并非总是完全可逆。
