Wyatt Christina M, Hoover Donald R, Shi Qiuhu, Tien Phyllis C, Karim Roksana, Cohen Mardge H, Goderre Johanna L, Seaberg Eric C, Lazar Jason, Young Mary A, Klotman Paul E, Anastos Kathryn
Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA.
Antivir Ther. 2011;16(4):591-6. doi: 10.3851/IMP1766.
We previously reported an increased risk of all-cause and AIDS mortality among HIV-infected women with albuminuria (proteinuria or microalbuminuria) enrolled in the Women's Interagency HIV Study (WIHS) prior to the introduction of HAART.
The current analysis includes 1,073 WIHS participants who subsequently initiated HAART. Urinalysis for proteinuria and semi-quantitative testing for microalbuminuria from two consecutive study visits prior to HAART initiation were categorized as follows: confirmed proteinuria (both specimens positive for protein), confirmed microalbuminuria (both specimens positive with at least one microalbuminuria), unconfirmed albuminuria (one specimen positive for proteinuria or microalbuminuria), or negative (both specimens negative). Time from HAART initiation to death was modelled using proportional hazards analysis.
Compared with the reference group of women with two negative specimens, the hazard ratio (HR) for all-cause mortality was significantly increased for women with confirmed microalbuminuria (HR 1.9, 95% CI 1.2-2.9). Confirmed microalbuminuria was also independently associated with AIDS death (HR 2.3, 95% CI 1.3-4.3), whereas women with confirmed proteinuria were at increased risk for non-AIDS death (HR 2.4, 95% CI 1.2-4.6).
In women initiating HAART, pre-existing microalbuminuria independently predicted increased AIDS mortality, whereas pre-existing proteinuria predicted increased risk of non-AIDS death. Urine testing may identify HIV-infected individuals at increased risk for mortality even after the initiation of HAART. Future studies should consider whether these widely available tests can identify individuals who would benefit from more aggressive management of HIV infection and comorbid conditions associated with mortality in this population.
我们之前报告过，在高效抗逆转录病毒治疗（HAART）引入之前，参与女性机构间HIV研究（WIHS）的合并蛋白尿（蛋白尿或微量白蛋白尿）的HIV感染女性全因死亡和艾滋病死亡风险增加。
当前分析纳入了1073名随后开始接受HAART的WIHS参与者。在开始HAART之前，对连续两次研究访视的蛋白尿进行尿液分析以及对微量白蛋白尿进行半定量检测，分类如下：确诊蛋白尿（两份标本蛋白质均呈阳性）；确诊微量白蛋白尿（两份标本至少有一份微量白蛋白尿呈阳性）；未确诊白蛋白尿（一份标本蛋白尿或微量白蛋白尿呈阳性）；或阴性（两份标本均为阴性）。使用比例风险分析对从开始HAART到死亡的时间进行建模。
与两份标本均为阴性的女性参照组相比，确诊微量白蛋白尿的女性全因死亡风险比（HR）显著增加（HR 1.9，95%置信区间1.2 - 2.9）。确诊微量白蛋白尿也与艾滋病死亡独立相关（HR 2.3，95%置信区间1.3 - 4.3），而确诊蛋白尿的女性非艾滋病死亡风险增加（HR 2.4，95%置信区间1.2 - 4.6）。
在开始HAART的女性中，既往存在的微量白蛋白尿独立预测艾滋病死亡增加，而既往存在的蛋白尿预测非艾滋病死亡风险增加。尿液检测可能识别出即使在开始HAART后死亡风险仍增加的HIV感染个体。未来研究应考虑这些广泛可用的检测是否能识别出可能从更积极管理HIV感染及该人群中与死亡相关的合并症中获益的个体。
