Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Rollins School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
J Acquir Immune Defic Syndr. 2019 May 1;81(1):e6-e9. doi: 10.1097/QAI.0000000000001999.
Antiretroviral therapy (ART) durability, time to modification or cessation, has declined. The study objective was to determine whether kidney dysfunction is contributing to reduced durability.
This retrospective follow-up study of CNICS evaluated treatment-naive PLWH initiating ART between 2007 and 2014. Regimen modification was defined as cessation/modification of any part of the 3-drug ART regimen. We evaluated the role of kidney dysfunction in initial regimen modification as both a mediator and effect measure modifier. Associations of the variables with the ART modification were examined using univariable and multivariable Cox proportional hazard models.
Of 4515 PLWH included in the analysis, 1967 modified their ART. Of those receiving TDF-based ART (n = 3888), 1580 (41%) modified their regimen compared with 387 (62%) receiving other regimens. Overall, the median eGFR decreased by 5 mL/min/1.73 m (quartiles: first = -16, third = 0) from baseline to follow-up. Of the 128 patients with low baseline eGFR (<60 mL/min/1.73 m), the final eGFR remained low in 73% while it increased to above 60 mL/min/1.73 m in 27%. Of the 4387 with normal baseline eGFR, only 135 (3%) had a final eGFR <60 mL/min/1.73 m. Those with low eGFR at the baseline and/or final visits were more likely to modify ART than others (hazards ratio = 1.75, 95% confidence interval: 1.39 to 2.19, P < 0.001). Relative to other regimens, TDF-based ART was less likely to be modified when accounting for numerous clinical and demographic traits.
For patients in our study initiated on ART, including TDF-based ART, in the last decade, kidney dysfunction is not a major factor leading to regimen modification.
抗逆转录病毒疗法（ART）的持久性、修改或停止时间已经下降。本研究的目的是确定肾功能障碍是否导致持久性降低。
这项对 CNICS 的回顾性随访研究评估了 2007 年至 2014 年间接受初始抗逆转录病毒治疗的未接受治疗的 PLWH。方案修改定义为停止/修改三药 ART 方案的任何部分。我们评估了肾功能障碍作为中介和效果修饰剂在初始方案修改中的作用。使用单变量和多变量 Cox 比例风险模型检查变量与 ART 修改之间的关联。
在纳入分析的 4515 名 PLWH 中，有 1967 名修改了他们的 ART。在接受 TDF 为基础的 ART（n = 3888）的患者中，1580 名（41%）修改了他们的方案，而接受其他方案的患者有 387 名（62%）。总体而言，中位 eGFR 从基线到随访时下降了 5 mL/min/1.73 m（四分位数：第一 = -16，第三 = 0）。在基线 eGFR 较低（<60 mL/min/1.73 m）的 128 名患者中，73%的患者最终 eGFR 仍然较低，而 27%的患者最终 eGFR 升高至 60 mL/min/1.73 m 以上。在基线 eGFR 正常的 4387 名患者中，仅有 135 名（3%）最终 eGFR <60 mL/min/1.73 m。基线和/或最终检查时 eGFR 较低的患者比其他患者更有可能修改 ART（风险比=1.75，95%置信区间：1.39 至 2.19，P<0.001）。在考虑到众多临床和人口统计学特征后，与其他方案相比，基于 TDF 的 ART 不太可能被修改。
在我们的研究中，在过去十年中，接受 ART 治疗的患者，包括基于 TDF 的 ART，肾功能障碍并不是导致方案修改的主要因素。
