Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Acquir Immune Defic Syndr. 2012 Aug 1;60(4):393-9. doi: 10.1097/QAI.0b013e31825b70d9.
Approximately, 15% of HIV-infected individuals have comorbid diabetes. Studies suggest that HIV and diabetes have an additive effect on chronic kidney disease (CKD) progression; however, this observation may be confounded by differences in traditional CKD risk factors.
We studied a national cohort of HIV-infected and matched HIV-uninfected individuals who received care through the Veterans Healthcare Administration. Subjects were divided into 4 groups based on baseline HIV and diabetes status, and the rate of progression to an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73m was compared using Cox-proportional hazards modeling to adjust for CKD risk factors.
About 31,072 veterans with baseline eGFR ≥45 mL/min/1.73m (10,626 with HIV only, 5088 with diabetes only, and 1796 with both) were followed for a median of 5 years. Mean baseline eGFR was 94 mL/min/1.73m, and 7% progressed to an eGFR < 45 mL/min/1.73m. Compared with those without HIV or diabetes, the relative rate of progression was increased in individuals with diabetes only [adjusted hazard ratio (HR) 2.48; 95% confidence interval (CI): 2.19 to 2.80], HIV only [HR: 2.80, 95% CI: 2.50 to 3.15], and both HIV and diabetes [HR: 4.47, 95% CI: 3.87 to 5.17].
Compared with patients with only HIV or diabetes, patients with both diagnoses are at significantly increased risk of progressive CKD even after adjusting for traditional CKD risk factors. Future studies should evaluate the relative contribution of complex comorbidities and accompanying polypharmacy to the risk of CKD in HIV-infected individuals and prospectively investigate the use of cART, glycemic control, and adjunctive therapy to delay CKD progression.
大约 15%的 HIV 感染者同时患有糖尿病。研究表明，HIV 和糖尿病对慢性肾脏病（CKD）的进展有叠加作用；然而，这种观察结果可能因传统 CKD 风险因素的差异而产生偏差。
我们研究了一个全国性的 HIV 感染者队列和匹配的 HIV 未感染者队列，他们通过退伍军人医疗保健管理局接受治疗。根据基线 HIV 和糖尿病状况，将受试者分为 4 组，并使用 Cox 比例风险模型比较进展为估计肾小球滤过率（eGFR）<45 mL/min/1.73m 的比率，以调整 CKD 风险因素。
大约 31072 名基线 eGFR≥45 mL/min/1.73m 的退伍军人（10626 名仅有 HIV，5088 名仅有糖尿病，1796 名同时患有 HIV 和糖尿病）接受了中位时间为 5 年的随访。平均基线 eGFR 为 94 mL/min/1.73m，7%的人进展为 eGFR<45 mL/min/1.73m。与无 HIV 或糖尿病的患者相比，仅患有糖尿病的患者进展的相对风险增加[调整后的危险比（HR）为 2.48；95%置信区间（CI）：2.19 至 2.80]，仅患有 HIV 的患者[HR：2.80，95% CI：2.50 至 3.15]，同时患有 HIV 和糖尿病的患者[HR：4.47，95% CI：3.87 至 5.17]。
与仅有 HIV 或糖尿病的患者相比，即使调整了传统 CKD 风险因素，同时患有这两种疾病的患者发生 CKD 进行性进展的风险显著增加。未来的研究应评估复杂合并症和伴随的多药治疗对 HIV 感染者 CKD 风险的相对贡献，并前瞻性研究 cART、血糖控制和辅助治疗对延缓 CKD 进展的作用。
