Mapesi Herry, Kalinjuma Aneth V, Ngerecha Alphonce, Franzeck Fabian, Hatz Christoph, Tanner Marcel, Mayr Michael, Furrer Hansjakob, Battegay Manuel, Letang Emilio, Weisser Maja, Glass Tracy R
Ifakara Branch, Ifakara Health Institute, Ifakara, Tanzania.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Open Forum Infect Dis. 2018 Apr 6;5(4):ofy072. doi: 10.1093/ofid/ofy072. eCollection 2018 Apr.
We assessed the prevalence, incidence, and predictors of renal impairment among people living with HIV (PLWHIV) in rural Tanzania.
In a cohort of PLWHIV aged ≥15 years enrolled from January 2013 to June 2016, we assessed the association between renal impairment (estimated glomerural filtration rate < 90 mL/min/1.73 m) at enrollment and during follow-up with demographic and clinical characteristcis using logistic regression and Cox proportional hazards models.
Of 1093 PLWHIV, 172 (15.7%) had renal impairment at enrollment. Of 921 patients with normal renal function at baseline, 117 (12.7%) developed renal impairment during a median follow-up (interquartile range) of 6.2 (0.4-14.7) months. The incidence of renal impairment was 110 cases per 1000 person-years (95% confidence interval [CI], 92-132). At enrollment, logistic regression identified older age (adjusted odds ratio [aOR], 1.79; 95% CI, 1.52-2.11), hypertension (aOR, 1.84; 95% CI, 1.08-3.15), CD4 count <200 cells/mm (aOR, 1.80; 95% CI, 1.23-2.65), and World Health Organization (WHO) stage III/IV (aOR, 3.00; 95% CI, 1.96-4.58) as risk factors for renal impairment. Cox regression model confirmed older age (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.56-2.20) and CD4 count <200 cells/mm (aHR, 2.05; 95% CI, 1.36-3.09) to be associated with the development of renal impairment.
Our study found a low prevalence of renal impairment among PLWHIV despite high usage of tenofovir and its association with age, hypertension, low CD4 count, and advanced WHO stage. These important and reassuring safety data stress the significance of noncommunicable disease surveillance in aging HIV populations in sub-Saharan Africa.
我们评估了坦桑尼亚农村地区艾滋病毒感染者（PLWHIV）中肾功能损害的患病率、发病率及预测因素。
在2013年1月至2016年6月纳入的年龄≥15岁的PLWHIV队列中，我们使用逻辑回归和Cox比例风险模型评估了入组时及随访期间肾功能损害（估计肾小球滤过率<90 mL/min/1.73 m²）与人口统计学和临床特征之间的关联。
在1093名PLWHIV中，172名（15.7%）入组时存在肾功能损害。在基线肾功能正常的921名患者中，117名（12.7%）在中位随访时间（四分位间距）6.2（0.4 - 14.7）个月期间出现肾功能损害。肾功能损害的发病率为每1000人年110例（95%置信区间[CI]，92 - 132）。入组时，逻辑回归确定年龄较大（调整优势比[aOR]，1.79；95%CI，1.52 - 2.11）、高血压（aOR，1.84；95%CI，1.08 - 3.15）、CD4细胞计数<200个/mm³（aOR，1.80；95%CI，1.23 - 2.65）以及世界卫生组织（WHO）III/IV期（aOR，3.00；95%CI，1.96 - 4.58）为肾功能损害的危险因素。Cox回归模型证实年龄较大（调整风险比[aHR]，1.85；95%CI，1.56 - 2.20）和CD4细胞计数<200个/mm³（aHR，2.05；95%CI，1.36 - 3.09）与肾功能损害的发生相关。
我们的研究发现，尽管替诺福韦使用率很高，但PLWHIV中肾功能损害的患病率较低，且其与年龄、高血压、低CD4细胞计数和WHO晚期相关。这些重要且令人安心的安全性数据强调了撒哈拉以南非洲老年艾滋病毒人群中非传染性疾病监测的重要性。
