Chikwapulo Bongani, Ngwira Bagrey, Sagno Jean Baptiste, Evans Rhys
1 Department of Public Health, College of Medicine, University of Malawi College of Medicine, University of Malawi, Blantyre, Malawi.
2 Department of Environmental Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Int J STD AIDS. 2018 Jun;29(7):650-657. doi: 10.1177/0956462417749733. Epub 2018 Jan 16.
Tenofovir-based antiretroviral therapy (TDF ART) is the first-line regimen for human immunodeficiency virus (HIV) in Africa. However, contemporary data on nephrotoxicity are lacking. We determined the renal outcomes of patients commenced on TDF ART in Malawi. ART-naïve patients initiated on TDF ART at a community health centre between 1 July 2013 and 31 December 2015 were included. The estimated glomerular filtration rate (eGFR, Cockcroft-Gault) was recorded at the initiation of therapy and over 18 months thereafter. The prevalence of renal impairment at ART initiation (eGFR < 60 ml/min) and the incidence of nephrotoxicity (eGFR < 50 ml/min) were determined. A total of 439 patients (median age: 32 years; 317 [72.2%] female) were included. Twenty-one (4.8%) patients had renal impairment at ART initiation; eGFR improved in all during follow-up. Nephrotoxicity occurred in 17 (4.0%) patients with eGFR > 50 ml/min at baseline, predominantly within the first six months of therapy. Increasing age and diastolic hypertension (>100 mmHg) were independent risk factors for nephrotoxicity development. The prevalence of kidney disease at ART initiation was 4.8% and nephrotoxicity occurred in 4.0%. Some eGFR decline may have been due to weight gain. Targeted monitoring of kidney function six months after TDF initiation should be considered in Malawi.
基于替诺福韦的抗逆转录病毒疗法（TDF ART）是非洲治疗人类免疫缺陷病毒（HIV）的一线治疗方案。然而，目前缺乏关于肾毒性的当代数据。我们确定了马拉维开始接受TDF ART治疗的患者的肾脏转归情况。纳入了2013年7月1日至2015年12月31日期间在社区卫生中心开始接受TDF ART治疗的初治患者。在治疗开始时及之后的18个月内记录估算肾小球滤过率（eGFR，Cockcroft-Gault公式）。确定了开始抗逆转录病毒治疗时肾功能损害的患病率（eGFR＜60 ml/分钟）及肾毒性的发生率（eGFR＜50 ml/分钟）。共纳入439例患者（中位年龄：32岁；317例[72.2%]为女性）。21例（4.8%）患者在开始抗逆转录病毒治疗时存在肾功能损害；随访期间所有患者的eGFR均有所改善。17例（4.0%）患者在基线时eGFR＞50 ml/分钟，发生了肾毒性，主要发生在治疗的前6个月内。年龄增加和舒张期高血压（＞100 mmHg）是发生肾毒性的独立危险因素。开始抗逆转录病毒治疗时肾脏疾病的患病率为4.8%，肾毒性发生率为4.0%。部分eGFR下降可能与体重增加有关。马拉维应考虑在开始使用TDF治疗6个月后针对性地监测肾功能。
