接受高效抗逆转录病毒治疗的加纳艾滋病毒感染患者的肾功能：一项病例对照研究。
Renal function in Ghanaian HIV-infected patients on highly active antiretroviral therapy: a case-control study.
作者信息
Obirikorang Christian, Osakunor Derick Nii Mensah, Ntaadu Benedict, Adarkwa Opei Kwafo
机构信息
Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
出版信息
PLoS One. 2014 Jun 12;9(6):e99469. doi: 10.1371/journal.pone.0099469. eCollection 2014.
BACKGROUND
HAART is anticipated to result in an increase in long-term survival, but may present with the development of associated complications. The aim of this study was to assess the renal function of HIV-infected patients on antiretroviral therapy.
METHODS
A case-control study (January to May 2013) conducted at the Suntreso Government Hospital, Kumasi, Ghana. A total of 163 HIV-infected patients (mean age 39.9±10.22) were studied, of which 111 were on HAART (HIV-HAART) and 52 were not (HIV-Controls). Serum urea, creatinine, potassium, sodium, chloride and CD4 counts were measured with the determination of eGFR (CKD-EPI and MDRD). Data was analysed using GraphPad Prism. The Chi-square, t-test, one-way ANOVA and Spearman's correlation were used. P values <0.05 were considered significant.
RESULTS
Mean CD4 count of HIV-Controls was higher than that of HIV-HAART but was not significant (p = 0.304). But for sodium levels which were higher in HIV-Controls (p = 0.0284), urea (p = 0.1209), creatinine (p = 0.7155), potassium (p = 0.454) and chloride (p = 0.6282) levels did not differ significantly between both groups. All serum biochemical parameters did not differ significantly, irrespective of duration on therapy and CD4 counts. Based on regimen, sodium, chloride, urea and creatinine did not differ significantly between TDF, EVF and NVP-based therapies. Prevalence of CKD (eGFR <60 ml/min/1.73 m2) in the total population was 9.9% and 3.7% with the MDRD and EPI-CKD equations respectively.
CONCLUSIONS
Renal insufficiency remains prevalent in HIV patients. Changes in renal function occur in HIV infection and over the course of HAART but the difference at either stage is not significant. This suggests the role of HIV infection, HAART and the presence of traditional risk factors but not HAART in itself, in renal dysfunction. We however recommend a close monitoring of patients before and during HAART, to aid in evaluating drug combinations and implement dose modifications when necessary.
背景
高效抗逆转录病毒疗法（HAART）有望提高长期生存率，但可能会出现相关并发症。本研究的目的是评估接受抗逆转录病毒治疗的HIV感染患者的肾功能。
方法
2013年1月至5月在加纳库马西的孙特雷索政府医院进行了一项病例对照研究。共研究了163例HIV感染患者（平均年龄39.9±10.22岁），其中111例接受HAART治疗（HIV-HAART组），52例未接受HAART治疗（HIV-对照组）。检测血清尿素、肌酐、钾、钠、氯水平及CD4细胞计数，并计算估算肾小球滤过率（eGFR，采用慢性肾脏病流行病学协作组（CKD-EPI）公式和肾脏病饮食改良试验（MDRD）公式）。数据采用GraphPad Prism软件进行分析。使用卡方检验、t检验、单因素方差分析和Spearman相关性分析。P值<0.05被认为具有统计学意义。
结果
HIV-对照组的平均CD4细胞计数高于HIV-HAART组，但差异无统计学意义（p = 0.304）。除HIV-对照组的钠水平较高外（p = 0.0284），两组间尿素（p = 0.1209）、肌酐（p = 0.7155）、钾（p = 0.454）和氯（p = 0.6282）水平差异均无统计学意义。无论治疗时间和CD4细胞计数如何，所有血清生化参数差异均无统计学意义。基于治疗方案，替诺福韦（TDF）、依法韦仑（EVF）和奈韦拉平（NVP）治疗方案之间的钠、氯、尿素和肌酐水平差异均无统计学意义。采用MDRD公式和CKD-EPI公式计算，总人群中慢性肾脏病（eGFR<60 ml/min/1.73 m2）的患病率分别为9.9%和3.7%。
结论
肾功能不全在HIV患者中仍然普遍存在。HIV感染及HAART治疗过程中均会出现肾功能变化，但在任何一个阶段差异均无统计学意义。这表明HIV感染、HAART以及传统危险因素的存在与肾功能障碍有关，但并非HAART本身。然而，我们建议在HAART治疗前和治疗期间密切监测患者，以帮助评估药物组合并在必要时调整剂量。
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