Department of Medicine, Surgery and Dentistry, University of Milan, Milan, Italy.
HIV Med. 2011 Jan;12(1):4-13. doi: 10.1111/j.1468-1293.2010.00855.x.
The prevalence and factors associated with an increased risk of renal dysfunction in HIV-infected patients receiving or not receiving antiretroviral therapy (ART) have been poorly evaluated in observational settings.
Patients in the ICONA Foundation cohort with at least two creatinine values available while still ART-naïve were enrolled in the study. A logistic regression analysis was performed to identify predictors of an estimated glomerular filtration rate (eGFR)<90 mL/min/1.73 m(2) at baseline. The incidence and predictors of a >20% reduction in eGFR from pre-combination ART (cART) levels (or a decrease from ≥90 to <90 mL/min/1.73 m(2) ) were evaluated by Poisson regression.
A total of 1505 patients were included in the study; 363 (24%) had eGFR<90 mL/min/1.73 m(2) at baseline. Older patients [odds ratio (OR) 1.58 per 10 years older; P<0.00001], female patients (OR 2.41 vs. male patients; P<0.00001), those who had diabetes and/or hypertension (OR 2.36 vs. neither; P<0.03) and patients with higher baseline CD4 count (OR 1.06 per 100 cells/μL higher; P<0.03) showed a greater risk of eGFR<90 mL/min/1.73 m(2) . Ninety-six patients experienced an eGFR decrease of >20% from pre-cART levels (6.8 per 100 person-years). Older age [relative risk (RR) 1.41 per 10 years older; P=0.005], female gender (RR 2.25 vs. male; P=0.003) and current exposure to didanosine (ddI), tenofovir and protease inhibitors were the major determinants.
We observed a relatively high rate of mild renal dysfunction in the absence of ART. In addition to traditional risk factors such as older age and diabetes/hypertension, female gender and current use of ddI, tenofovir and protease inhibitors were associated with a greater risk of decreased renal function as measured by eGFR.
在观察性研究中，接受或未接受抗逆转录病毒治疗（ART）的 HIV 感染者中，肾功能障碍风险增加的流行情况和相关因素尚未得到充分评估。
ICONA 基金会队列中至少有两次肌酐值可供分析且仍未接受 ART 的患者被纳入本研究。采用 logistic 回归分析确定基线时估算肾小球滤过率（eGFR）<90ml/min/1.73m(2)的预测因子。通过泊松回归评估 cART 前（cART）eGFR 降低>20%（或从≥90 降至<90ml/min/1.73m(2)）的发生率和预测因子。
共纳入 1505 例患者，基线时 363 例（24%）eGFR<90ml/min/1.73m(2)。年龄较大的患者（每增加 10 岁，比值比[OR]为 1.58；P<0.00001）、女性患者（OR 为 2.41 比男性患者；P<0.00001）、合并糖尿病和/或高血压的患者（OR 为 2.36 比均无该疾病的患者；P<0.03）和基线 CD4 计数较高的患者（每增加 100 个细胞/μL，OR 为 1.06；P<0.03）eGFR<90ml/min/1.73m(2)的风险更高。96 例患者发生 cART 前 eGFR 降低>20%（每 100 人年 6.8 例）。年龄较大（每增加 10 岁，相对风险[RR]为 1.41；P=0.005）、女性（RR 为 2.25 比男性；P=0.003）和当前使用 ddI、替诺福韦和蛋白酶抑制剂是主要决定因素。
我们观察到在未接受 ART 的情况下，肾功能轻度障碍的发生率相对较高。除了年龄较大和糖尿病/高血压等传统危险因素外，女性性别和当前使用 ddI、替诺福韦和蛋白酶抑制剂与 eGFR 降低的肾功能损害风险增加相关。
