Fritzsche Carlos, Rudolph Jens, Huenten-Kirsch Barbara, Hemmer Christoph J, Tekoh Robert, Kuwoh Pius B, Glass Aenne, Reisinger Emil C
Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University Medical School of Rostock, Rostock, Germany.
Regional Hospital Limbe, Limbe, Cameroon.
Am J Trop Med Hyg. 2017 Nov;97(5):1445-1450. doi: 10.4269/ajtmh.17-0060.
In Sub-Saharan Africa, the prevalence of HIV-associated kidney diseases is as high as 53.3%. Combined antiretroviral treatment (cART), especially tenofovir disoproxil fumarate (TDF), is known to be nephrotoxic. We undertook this cross-sectional study conducted in 2015 at the Regional Hospital Limbe in the Southwest Region of Cameroon to determine the prevalence of renal dysfunction and its correlates among treatment-experienced HIV-infected patients on TDF and treatment-naïve patients. In April 2016, a follow-up was performed on those who had been treatment-naïve and were started on cART after enrolment in the study. We compared 119 patients on TDF-containing regimens with 47 treatment-naïve patients. Proteinuria was significantly more prevalent, and creatinine was significantly higher among treatment-naïve patients than among those on treatment (52.2% versus 26.1%; = 0.003 and = 0.009, respectively). The proportion of patients with an estimated glomerular filtration rate (eGFR) < 60 mL/minute was significantly higher among treatment-naïve patients than among those on TDF treatment (40.4% versus 24.4%; = 0.041). Treatment-naïve patients displayed an improvement in creatinine levels and eGFR after 6 months of treatment. To the best of our knowledge, this is the first study to investigate the impact of TDF on renal parameters in Cameroon. TDF appears to be safe and does not appear to be a significant cause of renal impairment. However, renal parameters should be monitored regularly, as recommended by the guidelines.
在撒哈拉以南非洲地区，与艾滋病毒相关的肾脏疾病患病率高达53.3%。已知联合抗逆转录病毒治疗（cART），尤其是替诺福韦酯（TDF）具有肾毒性。我们于2015年在喀麦隆西南地区的林贝地区医院开展了这项横断面研究，以确定在接受过治疗的TDF治疗的艾滋病毒感染患者和未接受过治疗的患者中肾功能不全的患病率及其相关因素。2016年4月，对那些未接受过治疗且在研究入组后开始接受cART治疗的患者进行了随访。我们将119例接受含TDF方案治疗的患者与47例未接受过治疗的患者进行了比较。未接受过治疗的患者中蛋白尿的患病率显著更高，肌酐水平也显著高于接受治疗的患者（分别为52.2%对26.1%；P = 0.003和P = 0.009）。估计肾小球滤过率（eGFR）<60 mL/分钟的患者比例在未接受过治疗的患者中显著高于接受TDF治疗的患者（40.4%对24.4%；P = 0.041）。未接受过治疗的患者在治疗6个月后肌酐水平和eGFR有所改善。据我们所知，这是喀麦隆第一项研究TDF对肾脏参数影响的研究。TDF似乎是安全的，似乎不是肾功能损害的重要原因。然而，应按照指南建议定期监测肾脏参数。
