Cure Sandrine, Bianic Florence, Espinas Caroline, Hardy Helene, Rosenblatt Lisa, Juday Timothy
Health Economic and Outcomes Research, OptumInsight, Uxbridge, United Kingdom.
Health Economic and Outcomes Research, OptumInsight, Paris, France.
PLoS One. 2015 May 4;10(5):e0124666. doi: 10.1371/journal.pone.0124666. eCollection 2015.
Some HIV antiretroviral therapies (ART) have been associated with renal toxicities, which become of increasing concern as HIV-infected patients age and develop comorbidities. The objective of this study was to evaluate the relative impact of atazanavir (ATV)-based regimens on the renal function of adult patients with HIV. We conducted a systematic literature review by searching PubMed, EMBASE, Cochrane library, and the CRD from 2000 until March 2013. Major HIV-related conferences occurring in the past two years were also searched. All randomized clinical trials and large cohort studies assessing renal function in treatment-naïve and/or treatment-experienced HIV patients on ATV-based regimens were included. Fixed-effect mixed-treatment network analyses were carried out on the most frequently reported renal outcomes. 23 studies met the inclusion criteria, and change in estimated glomerular filtration rate (eGFR) from baseline to 48 weeks was identified as the main outcome. Two networks including, respectively, six studies (using the Cockcroft-Gault method) and four studies (using MDRD and CKD-EPI) were analysed. With CG network, ATV/r + TDF/FTC was associated with lower impact on the decline of eGFR than ATV/cobicistat + TDF/FTC but with higher decrease in eGFR than ATV/r + ABC/3TC (difference in mean change from baseline in eGFR respectively +3.67 and -3.89). The use of ATV/cobicistat + TDF/FTC led to a similar decline in eGFR as EVG/cobicistat/TDF/FTC. With respect to third agents combined with TDF/FTC, ATV/r had a lower increase in eGFR in comparison to EFV, and no difference was shown when compared to SQV/r and DRV/r. The effect of ATV-based regimens on renal function at 48 weeks appears similar to other ART regimens and appears to be modest regardless of boosting agent or backbone, although TDF containing backbones consistently leads to greater decline in eGFR.
一些抗逆转录病毒疗法（ART）与肾脏毒性有关，随着感染HIV的患者年龄增长和出现合并症，这一问题日益受到关注。本研究的目的是评估基于阿扎那韦（ATV）的治疗方案对成年HIV患者肾功能的相对影响。我们通过检索2000年至2013年3月的PubMed、EMBASE、Cochrane图书馆和CRD进行了系统的文献综述。还检索了过去两年中召开的主要HIV相关会议。纳入所有评估初治和/或经治HIV患者使用基于ATV的治疗方案时肾功能的随机临床试验和大型队列研究。对最常报告的肾脏结局进行固定效应混合治疗网络分析。23项研究符合纳入标准，将估算肾小球滤过率（eGFR）从基线到48周的变化确定为主要结局。分析了两个网络，分别包括六项研究（使用Cockcroft-Gault方法）和四项研究（使用MDRD和CKD-EPI）。在CG网络中，与ATV/考比司他+替诺福韦酯/恩曲他滨相比，ATV/利托那韦+替诺福韦酯/恩曲他滨对eGFR下降的影响较小，但与ATV/利托那韦+阿巴卡韦/拉米夫定相比，eGFR下降幅度更大（eGFR从基线的平均变化差异分别为+3.67和-3.89）。使用ATV/考比司他+替诺福韦酯/恩曲他滨导致的eGFR下降与埃替拉韦/考比司他/替诺福韦酯/恩曲他滨相似。关于与替诺福韦酯/恩曲他滨联合使用的第三种药物，与依非韦伦相比，ATV/利托那韦的eGFR升高幅度较小，与沙奎那韦/利托那韦和地瑞那韦/利托那韦相比无差异。基于ATV的治疗方案在48周时对肾功能的影响似乎与其他ART方案相似，且无论增效剂或主干药物如何，影响似乎都较小，尽管含替诺福韦酯的主干药物始终导致eGFR下降幅度更大。
