Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Hépatologie, Lyon, France.
J Viral Hepat. 2013 Sep;20(9):650-7. doi: 10.1111/jvh.12088. Epub 2013 Mar 5.
We aimed to compare the evolution of estimated glomerular filtration rate (eGFR) in HIV-, HIV-HBV- and HBV-infected patients treated with tenofovir disoproxil fumarate (TDF). Three groups of patients receiving TDF > 12 months were recruited: 194 HIV-infected patients, 85 HIV-HBV-coinfected patients and 50 HBV-infected patients. eGFR was estimated using the Modification of the Diet in Renal Disease (MDRD) equation. Multivariate regression models were constructed to estimate factors associated with eGFR decrease from baseline. A total of 329 patients were studied. Median follow-up was 2.7 years. Median eGFR decrease was -4.9 (-16.6 to +7.2) mL/min/1.73 m(2) . After multivariate stepwise regression analysis, age (P = 0.0002), non-African origin (P < 0.0001), baseline eGFR (P < 0.0001) and TDF duration (P = 0.02) were associated with eGFR decrease in the whole population, while hypertension, diabetes and type of infection were not. Age (P < 0.0001), non-African origin (P = 0.0004), baseline eGFR (P < 0.0001) and TDF duration (P = 0.007) remained associated with eGFR decline in HIV and HIV-HBV-infected patients, while other variables including HIV risk factor, CDC stage, CD4 and HIV-RNA levels were not. Age (P = 0.03), non-African origin (P = 0.004), baseline eGFR (P < 0.0001) and baseline HBV-DNA > 2000 IU/mL (P = 0.04) were associated with eGFR decline in HBV and HIV-HBV-infected patients, while other variables including HBV risk factor and fibrosis stage were not. Estimated glomerular filtration rate decline under TDF therapy appears mainly associated with older age, non-African origin, higher baseline eGFR and longer TDF administration but not with the type of viral infection. Regular follow-up of renal function, especially tubular function is recommended during TDF therapy.
我们旨在比较接受富马酸替诺福韦二吡呋酯（TDF）治疗的 HIV-、HIV-HBV-和 HBV 感染患者估算肾小球滤过率（eGFR）的变化。招募了三组接受 TDF 治疗超过 12 个月的患者：194 名 HIV 感染患者、85 名 HIV-HBV 合并感染患者和 50 名 HBV 感染患者。使用肾脏病饮食改良公式（MDRD）估算 eGFR。构建多变量回归模型以估计与基线时 eGFR 下降相关的因素。共研究了 329 名患者。中位随访时间为 2.7 年。中位 eGFR 下降为-4.9（-16.6 至+7.2）mL/min/1.73 m²。经过多变量逐步回归分析，年龄（P=0.0002）、非非洲裔起源（P<0.0001）、基线 eGFR（P<0.0001）和 TDF 持续时间（P=0.02）与整个人群的 eGFR 下降相关，而高血压、糖尿病和感染类型则没有。年龄（P<0.0001）、非非洲裔起源（P=0.0004）、基线 eGFR（P<0.0001）和 TDF 持续时间（P=0.007）与 HIV 和 HIV-HBV 感染患者的 eGFR 下降相关，而其他变量，包括 HIV 风险因素、CDC 分期、CD4 和 HIV-RNA 水平，则没有。年龄（P=0.03）、非非洲裔起源（P=0.004）、基线 eGFR（P<0.0001）和基线 HBV-DNA>2000IU/mL（P=0.04）与 HBV 和 HIV-HBV 感染患者的 eGFR 下降相关，而其他变量，包括 HBV 风险因素和纤维化分期，则没有。在 TDF 治疗下，估计肾小球滤过率下降主要与年龄较大、非非洲裔起源、较高的基线 eGFR 和较长的 TDF 给药时间相关，但与病毒感染类型无关。建议在 TDF 治疗期间定期监测肾功能，尤其是肾小管功能。
