Cheng Chien-Yu, Chang Shu-Yin, Lin Mei-Hui, Ku Shin-Yen, Sun Na-Lee, Cheng Shu-Hsing
Department of Internal Medicine, Division of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
AIDS Care Center, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.
J Infect Chemother. 2016 Nov;22(11):744-747. doi: 10.1016/j.jiac.2016.08.008. Epub 2016 Sep 6.
Tenofovir disoproxil fumarate (TDF) -containing regimens have been associated with nephrotoxicity and hypophosphatemia in HIV-infected patients. The objective of this study was to assess the possible risk factors for hypophosphatemia and evaluate the relationship between fractional excretion of filtered phosphate (FePi) and hypophosphatemia in TDF users.
Patients were enrolled in a prospective cohort study between January 2011 and December 2014. We classified experienced HIV-infected patients (individuals maintained on antiretroviral therapy (ART) for 6 months or more) and naïve patients into 3 treatment groups: TDF-containing ART (group 1), non-TDF-containing ART (never received TDF or had not received TDF in the past 6 months; group 2) and naive to antiretroviral therapy (group 3). Specimens from each individual were assessed for serum phosphate, serum creatinine, urine phosphate, and urine creatinine. Multivariable logistic regression was performed to control for the following variables measured at baseline: eGFR, age, sex, sexual orientation, injection drug use (IDUs), HIV-RNA viral load, and CD4 cell count.
The frequency of hypophosphatemia in groups 1, 2, and 3 was 20.2%, 7.2%, and 14.6%, respectively (P = 0.002). FePi above 10% also was significantly associated with hypophosphatemia (P = 0.003; adjusted odds ratio = 2.54). Patients with elevated CD4 cell counts (>500 cells/μL) exhibited a lower risk of hypophosphatemia (P = 0.002; adjusted odds ratio = 0.35).
Hypophosphatemia is a multifactorial etiology; FePi was confirmed as a suggested method to predict the risk of hypophosphatemia in TDF users. Clinical Trial Number: TYGH103011.
在感染HIV的患者中，含富马酸替诺福韦二吡呋酯（TDF）的治疗方案与肾毒性和低磷血症有关。本研究的目的是评估低磷血症的可能危险因素，并评估TDF使用者中滤过磷酸盐分数排泄（FePi）与低磷血症之间的关系。
2011年1月至2014年12月期间，患者被纳入一项前瞻性队列研究。我们将有经验的HIV感染患者（接受抗逆转录病毒治疗（ART）6个月或更长时间的个体）和初治患者分为3个治疗组：含TDF的ART组（第1组）、不含TDF的ART组（从未接受过TDF或在过去6个月内未接受过TDF；第2组）和未接受过抗逆转录病毒治疗的初治组（第3组）。对每个个体的样本进行血清磷酸盐、血清肌酐、尿磷酸盐和尿肌酐评估。进行多变量逻辑回归以控制在基线时测量的以下变量：估算肾小球滤过率（eGFR）、年龄、性别、性取向、注射吸毒（IDU）、HIV-RNA病毒载量和CD4细胞计数。
第1组、第2组和第3组的低磷血症发生率分别为20.2%、7.2%和14.6%（P = 0.002）。FePi高于10%也与低磷血症显著相关（P = 0.003；调整后的优势比 = 2.54）。CD4细胞计数升高（>500个/μL）的患者发生低磷血症的风险较低（P = 0.002；调整后的优势比 = 0.35）。
低磷血症病因是多因素的；FePi被确认为预测TDF使用者低磷血症风险的一种推荐方法。临床试验编号：TYGH103011。
