与未感染人类免疫缺陷病毒的对照者相比，感染人类免疫缺陷病毒的中年个体中慢性肾脏病的患病率更高，且进展更快。

Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls.

机构信息

Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development.

Department of Nephrology, Academic Medical Center.

出版信息

J Infect Dis. 2017 Sep 15;216(6):622-631. doi: 10.1093/infdis/jix202.

DOI:10.1093/infdis/jix202

PMID:28934420

Abstract

BACKGROUND

Human immunodeficiency virus (HIV)-infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute.

METHODS

We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2), albuminuria (albumin/creatinine ratio ≥3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93μg/mmol and/or fractional phosphate excretion >20% with plasma phosphate <0.8 mmol/L) in 596 HIV-infected and 544 HIV-uninfected AGEhIV Cohort Study participants. We also assessed whether being HIV-infected on cART, with follow-up censored when cART regimen was modified, was associated with greater eGFR decline or worsening albuminuria (increase ≥10%/year with change in albuminuria category).

RESULTS

Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0-4.4), albuminuria (aOR = 5.8; 95% CI = 3.7-9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9-10.2]). Among 377 HIV-infected and 479 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (-0.56; 95% CI = -0.87 to -0.24 mL/min/1.73m2/year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3-4.0).

CONCLUSIONS

In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus-infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.

摘要

背景

感染人类免疫缺陷病毒（HIV）的个体患慢性肾脏病（CKD）的风险增加。HIV 感染、传统的 CKD 危险因素以及联合抗逆转录病毒治疗（cART）都可能导致这种情况。

方法

我们比较了 596 名 HIV 感染和 544 名 HIV 未感染的 AGEhIV 队列研究参与者的肾功能损害（估计肾小球滤过率[eGFR]＜60 mL/min/1.73m2）、白蛋白尿（白蛋白/肌酐比值≥3 mg/mmol）和近端肾小管功能障碍（视黄醇结合蛋白/肌酐比值＞2.93μg/mmol 和/或分数磷排泄＞20%，同时血浆磷＜0.8 mmol/L）的患病率。我们还评估了 cART 时感染 HIV 以及当 cART 方案改变时进行随访时，与更大的 eGFR 下降或白蛋白尿恶化（白蛋白尿类别变化时每年增加≥10%）是否相关。

结果

HIV 感染与肾功能损害（调整后优势比[aOR]＝2.1；95%置信区间[CI]＝1.0-4.4）、白蛋白尿（aOR＝5.8；95%CI＝3.7-9.0）和近端肾小管功能障碍（aOR＝7.0；95%CI＝4.9-10.2）独立相关。在纳入纵向分析的 377 名 HIV 感染和 479 名 HIV 未感染的个体中（中位随访时间分别为 3.9/4.1 年），HIV 感染且未改变 cART 方案与更大的 eGFR 下降（-0.56；95%CI＝-0.87 至-0.24 mL/min/1.73m2/年）和白蛋白尿恶化（aOR＝2.3；95%CI＝1.3-4.0）独立相关。