Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
J Microbiol Immunol Infect. 2017 Oct;50(5):595-603. doi: 10.1016/j.jmii.2015.08.019. Epub 2015 Sep 9.
BACKGROUND/PURPOSE: Tenofovir disoproxil fumarate (TDF) is associated with kidney tubular dysfunction, for which the risk may vary among patients of different ethnicities. Data are limited, however, on the association between renal function changes and TDF exposure in human immunodeficiency virus (HIV)-infected Taiwanese patients.
Medical records of HIV-infected Taiwanese patients seeking HIV care at a university hospital from 2011 to 2014 were reviewed. The change of estimated glomerular filtration rate (eGFR) was compared between patients not receiving combination antiretroviral therapy (cART) and those starting cART with or without TDF. The determinants of annual eGFR changes and factors associated with greater annual eGFR decline in TDF-exposed patients were explored.
A total of 775 patients were included: 140 were cART-naïve, 393 received TDF-containing cART, and 242 received cART without TDF. Compared with cART-naïve patients, the annual eGFR decline was greater in TDF-exposed patients (0.57 ± 8.6 mL/min/1.73 m and 2.7 ± 8.9 mL/min/1.73 m, p = 0.012). The annual eGFR decline between patients receiving cART with or without TDF was similar (2.7 ± 8.9 mL/min/1.73 m and 1.8 ± 8.3 mL/min/1.73 m, p = 0.567). Diabetes was associated with worsening eGFR decline in all studied patients. TDF exposure correlated with an additional annual eGFR decline of 2.73 mL/min/1.73 m (95% confidence interval 0.139-5.326, p = 0.039) in patients with CD4 count < 350 cells/μL. Among TDF-exposed patients, the factors associated with annual eGFR decline of > 3 mL/min/1.73 m were higher baseline eGFR and lower CD4 counts.
Among HIV-infected Taiwanese patients, cART exposure correlated with the decline of renal function. However, TDF-exposed patients are more likely to have prominent eGFR decline, especially those with higher baseline eGFR, advanced HIV disease, and diabetes.
背景/目的：富马酸替诺福韦二吡呋酯（TDF）与肾小管功能障碍有关，不同种族的患者发生这种风险的可能性不同。然而，在感染人类免疫缺陷病毒（HIV）的台湾患者中，肾功能变化与 TDF 暴露之间的关系数据有限。
回顾了 2011 年至 2014 年在一家大学医院寻求 HIV 护理的 HIV 感染台湾患者的病历。比较了未接受联合抗逆转录病毒治疗（cART）和开始接受含或不含 TDF 的 cART 的患者的估算肾小球滤过率（eGFR）变化。探讨了年度 eGFR 变化的决定因素和 TDF 暴露患者中与更大年度 eGFR 下降相关的因素。
共纳入 775 例患者：140 例为 cART 初治，393 例接受含 TDF 的 cART，242 例接受不含 TDF 的 cART。与 cART 初治患者相比，TDF 暴露患者的年度 eGFR 下降更大（0.57±8.6 mL/min/1.73 m 和 2.7±8.9 mL/min/1.73 m，p=0.012）。接受含或不含 TDF 的 cART 的患者的年度 eGFR 下降相似（2.7±8.9 mL/min/1.73 m 和 1.8±8.3 mL/min/1.73 m，p=0.567）。在所有研究患者中，糖尿病与 eGFR 恶化相关。在 CD4 计数<350 个细胞/μL 的患者中，TDF 暴露与额外的年度 eGFR 下降 2.73 mL/min/1.73 m（95%置信区间 0.139-5.326，p=0.039）相关。在 TDF 暴露患者中，与年度 eGFR 下降>3 mL/min/1.73 m 相关的因素是较高的基线 eGFR 和较低的 CD4 计数。
在感染 HIV 的台湾患者中，cART 暴露与肾功能下降相关。然而，TDF 暴露患者更有可能出现明显的 eGFR 下降，尤其是那些基线 eGFR 较高、HIV 疾病晚期和患有糖尿病的患者。
