Zhao Yan, Zhang Mingjie, Shi Cynthia X, Zhang Yao, Cai Weiping, Zhao Qingxia, Li Yong, Li Huiqin, Liu Xia, Chen Limeng, Ma Ye, Zhang Fujie, Liu Zhongfu, Wu Zunyou
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Guangzhou 8th Hospital, Guangdong, China.
PLoS One. 2015 Aug 28;10(8):e0135462. doi: 10.1371/journal.pone.0135462. eCollection 2015.
To identify the prevalence and predictors of abnormal renal function among HIV-positive Chinese patients prior to antiretroviral therapy (ART) initiation and to evaluate subsequent changes in renal function after ART exposure.
We conducted a nationwide cohort study of subjects who enrolled in the national Chinese ART program from January 1, 2012 to December 31, 2012. We estimated the glomerular filtration rate (eGFR) of subjects prior to and after initiating ART. Risk factors for abnormal renal function, as defined by eGFR <60 ml/min/1.73m2, at baseline and follow-up were assessed by logistic regression and Cox proportional hazards regression models, respectively.
Among 41,862 subjects, at ART baseline, 3.3% had a baseline eGFR <60 ml/min/1.73m2 and 24.2% had eGFR = 60-90 ml/min/1.73m2. Adjusted baseline risk factors for baseline eGFR <60 ml/min/1.73m2 were older age (Adjusted odds ratio [AOR] = 5.19, 95% confidence interval [CI]: 4.52-5.67), female (AOR = 1.68, 95% CI: 1.47-1.93), hemoglobin <120g/L (AOR = 1.68, 95% CI: 1.47-1.93), blood glucose >6.1 mmol/L (AOR = 1.46, 95% CI: 1.25-1.72), and hepatitis C co-infection (AOR = 1.36, 95% CI: 1.06-1.73). Among subjects with baseline eGFR >90 ml/min/1.73m2, the incidence of the eGFR falling to <60 ml/min/1.73m2 was 0.92/100 person-years after a median of 15.0 months of ART. Being on a tenofovir with lopinavir/ritonavir regimen (Adjusted hazard ratio [AHR] = 3.02, 95% CI: 1.96-4.66) and having an unsuppressed viral load (AHR = 2.70, 95% CI: 1.80-4.03) were independent predictors for eGFR <60 ml/min/1.73m2 after ART initiation as well as older age, female, and hemoglobin <120 g/L.
A high proportion of HIV-positive subjects in China presented with abnormal renal function prior to ART initiation. But the incidence of the eGFR decrease after ART was low. Patient renal function should be regularly monitored by eGFR before initiating and during ART.
确定中国HIV阳性患者在开始抗逆转录病毒治疗（ART）之前肾功能异常的患病率及预测因素，并评估ART治疗后肾功能的后续变化。
我们对2012年1月1日至2012年12月31日参加中国国家ART项目的受试者进行了一项全国性队列研究。我们估算了受试者开始ART之前和之后的肾小球滤过率（eGFR）。分别通过逻辑回归和Cox比例风险回归模型评估基线和随访时eGFR<60 ml/min/1.73m²定义的肾功能异常的危险因素。
在41862名受试者中，ART基线时，3.3%的受试者基线eGFR<60 ml/min/1.73m²，24.2%的受试者eGFR=60-90 ml/min/1.73m²。基线eGFR<60 ml/min/1.73m²的校正基线危险因素为年龄较大（校正比值比[AOR]=5.19，95%置信区间[CI]：4.52-5.67）、女性（AOR=1.68，95%CI：1.47-1.93）、血红蛋白<120g/L（AOR=1.68，95%CI：1.47-1.93）、血糖>6.1 mmol/L（AOR=1.46，95%CI：1.25-1.72）和丙型肝炎合并感染（AOR=1.36，95%CI：1.06-1.73）。在基线eGFR>90 ml/min/1.73m²的受试者中，ART治疗中位数15.0个月后，eGFR降至<60 ml/min/1.73m²的发生率为0.92/100人年。接受替诺福韦与洛匹那韦/利托那韦联合治疗方案（校正风险比[AHR]=3.02，95%CI：1.96-4.66）以及病毒载量未得到抑制（AHR=2.70，95%CI：1.80-4.03）是ART开始后eGFR<60 ml/min/1.73m²的独立预测因素，年龄较大、女性和血红蛋白<120 g/L也是如此。
中国高比例的HIV阳性受试者在开始ART之前存在肾功能异常。但ART治疗后eGFR下降的发生率较低。在开始ART之前和治疗期间，应通过eGFR定期监测患者的肾功能。
