Copenhagen HIV Programme, University of Copenhagen, Copenhagen N, Denmark.
Curr HIV/AIDS Rep. 2012 Jun;9(2):111-20. doi: 10.1007/s11904-012-0110-3.
Several observational studies have identified tenofovir as an independent risk factor for kidney impairment. Conversely, randomized trials have only demonstrated minor tenofovir-related changes in kidney function, but these studies included patients with normal kidney function and with low underling risk for progression of their renal function, had limited size, and limited follow-up. Several potential mechanisms of tenofovir nephrotoxicity are known. Atazanavir can, equally to indinavir, cause urolithiasis, but both drugs have also been associated with chronic kidney disease (CKD) and fast declining eGFR in persons without clinical symptoms of urolithiasis, especially when the plasma drug concentration is boosted by concomitant ritonavir use. In 2012, only a minority of HIV-positive individuals are affected by drug-induced nephrotoxicity. However, in the future, the clinical impact and hence the requirement for more research in this area will likely increase due to ageing and continued cART exposure of the HIV-positive population.
几项观察性研究已经确定替诺福韦是肾功能损害的一个独立危险因素。相反，随机试验仅显示替诺福韦相关的肾功能有轻微变化，但这些研究纳入了肾功能正常和肾功能进展风险低的患者，研究规模有限，随访时间有限。替诺福韦肾毒性有几个潜在的机制。阿扎那韦与茚地那韦同样可引起尿路结石，但这两种药物也与慢性肾脏病（CKD）和无尿路结石临床症状者的 eGFR 快速下降有关，尤其是当同时使用利托那韦增加了血浆药物浓度时。2012 年，只有少数 HIV 阳性个体受到药物引起的肾毒性的影响。然而，未来随着 HIV 阳性人群的老龄化和持续的 cART 暴露，该领域的临床影响，因此对更多研究的需求可能会增加。
