Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Central Clinical School, University of Sydney, Sydney, NSW, Australia.
PLoS One. 2019 Jan 17;14(1):e0210106. doi: 10.1371/journal.pone.0210106. eCollection 2019.
Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) significantly reduces the risk of HIV acquisition. TDF is a known nephrotoxin however, renal dysfunction from TDF is mostly reversible following discontinuation.
To describe the renal function, risk factors for renal disease and associated clinical testing practices in a cohort of PrEP patients.
A retrospective review was conducted of all PrEP patients commenced on TDF/FTC at an inner metropolitan sexual health clinic in Sydney, Australia between April 2016 and July 2017, with follow-up data obtained at 3-monthly intervals until 18 months.
525 patients met inclusion criteria. Patients were almost exclusively male and median age was 34 years (IQR: 28 to 42). At baseline, 1.5% had an estimated glomerular filtration rate (eGFR) <70 mL/min/1.73m2. A small significant drop in eGFR of -2.5 mL/min/1.73m2 (p<0.05) occurred between PrEP commencement and the first follow-up period, followed by a progressive decline in eGFR of -0.38 mL/min/1.73m2 per month (95%CI: -0.57 to -0.20; p<0.001). Renal impairment (eGFR <70 mL/min/1.73m2) occurred in 6.5% of patients and persisted across consecutive follow-up periods in five (1.0%) patients. Patients aged ≥40 years had a greater risk of renal impairment than younger patients (HR 3.9, 95%CI: 1.8 to 8.4; p<0.001), despite similar rates of eGFR decline (p = 0.19). PrEP was discontinued in two patients (0.4%) due to renal function concerns.
PrEP use led to an initial drop in eGFR and a more gradual progressive decline subsequently, but significant renal impairment remained uncommon up to 18 months of follow-up.
替诺福韦二吡呋酯/恩曲他滨（TDF/FTC）的暴露前预防（PrEP）可显著降低 HIV 感染的风险。然而，TDF 是一种已知的肾毒物，TDF 引起的肾功能障碍在停药后大多是可逆的。
描述一组接受 TDF/FTC 预防的 PrEP 患者的肾功能、肾脏疾病的危险因素以及相关的临床检测实践。
对 2016 年 4 月至 2017 年 7 月期间在澳大利亚悉尼一家市区性健康诊所接受 TDF/FTC 预防的所有 PrEP 患者进行了回顾性研究，在 18 个月的随访期间，每 3 个月进行一次随访以获取数据。
525 名患者符合纳入标准。患者几乎均为男性，中位年龄为 34 岁（IQR：28 至 42）。基线时，1.5%的患者估计肾小球滤过率（eGFR）<70mL/min/1.73m2。PrEP 开始至第一个随访期间，eGFR 出现小幅度的显著下降（-2.5mL/min/1.73m2，p<0.05），随后每月逐渐下降 0.38mL/min/1.73m2（95%CI：-0.57 至 -0.20；p<0.001）。6.5%的患者出现肾功能损害（eGFR<70mL/min/1.73m2），其中 5 名（1.0%）患者的肾功能损害在连续的随访期持续存在。年龄≥40 岁的患者发生肾功能损害的风险高于年龄较轻的患者（HR 3.9，95%CI：1.8 至 8.4；p<0.001），尽管 eGFR 下降率相似（p = 0.19）。由于肾功能问题，有 2 名患者（0.4%）停止了 PrEP 治疗。
PrEP 使用后 eGFR 最初下降，随后逐渐出现更缓慢的下降，但在 18 个月的随访期间，肾功能严重损害仍不常见。
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