Department of Infectious and Immune Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China; Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Infectious and Immune Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Int J Infect Dis. 2019 Jun;83:64-71. doi: 10.1016/j.ijid.2019.03.034. Epub 2019 Apr 2.
Tenofovir disoproxil fumarate (TDF) is an important component of antiretroviral therapy (ART) that has been widely used. The aim of this study was to observe the long-term impact of TDF-based ART on lipid metabolism profiles and renal functions in Chinese patients.
414 and 124 HIV-infected, ART-naïve patients who initiated TDF-based regimens and non-TDF regimens respectively were retrospectively included. Demographic characteristics and clinical information of each patient was collected. Changes of lipid profiles and renal function, as well as the risk factors of hyperlipidemia and renal dysfunction were analyzed.
After 96 weeks of ART, HIV viral loads were undetectable in 97.34% (403/414) of patients exposed to TDF. The plasma total cholesterol (TCH) increased from 3.97 ± 0.83 mmol/L to 4.53 ± 0.87 mmol/L (P < 0.001), which did not show a significant difference comparing with non-TDF exposed group. By contrast, the plasma triglyceride (TG) levels increased, but were still lower than that in the non-TDF exposed group (0.26 ± 1.24 vs. 0.89 ± 1.78, P < 0.001). The mean estimated glomerular filtration rate (eGFR) decreased from 127.29 ± 24.04ml∙min∙1.73 m at baseline to 118.84 ± 22.74 ml∙min∙1.73 m(P < 0.001) in the TDF exposed group, while it increased in the non-TDF exposed group. In the TDF group, high body mass index (BMI) (OR = 1.13, P = 0.01), high baseline TG (OR = 2.33, P<0.001) and receiving protease inhibitors (PIs) (OR = 7.58, P < 0.001) were associated with hypertriglyceridemia after ART, while high baseline TCH predicted hypercholesterolemia (OR = 3.58, P < 0.001). MSM (OR = 0.22, P = 0.02) and baseline eGFR (OR = 0.90, P < 0.001) was associated with renal dysfunction after ART.
TDF-based regimens are of good therapeutic effect among Chinese people. These regimens showed a better plasma lipid profile but mild renal dysfunction as compared to non-TDF based regimens. Patients with high BMI, high baseline TG, high baseline TCH and low baseline eGFR should be closely monitored when using TDF-based ART.
富马酸替诺福韦二吡呋酯（TDF）是抗逆转录病毒疗法（ART）的重要组成部分，已被广泛应用。本研究旨在观察 TDF 为基础的 ART 对中国患者脂代谢谱和肾功能的长期影响。
回顾性纳入 414 例和 124 例初治、接受 TDF 为基础方案和非 TDF 方案的 HIV 感染、ART 初治患者。收集每位患者的人口统计学特征和临床信息。分析脂代谢谱和肾功能的变化，以及血脂异常和肾功能障碍的危险因素。
在接受 TDF 治疗的 414 例患者中，97.34%（403/414）的 HIV 病毒载量在 96 周的 ART 后不可检测。血浆总胆固醇（TCH）从 3.97±0.83mmol/L 增加到 4.53±0.87mmol/L（P<0.001），与非 TDF 暴露组相比无显著差异。相比之下，血浆甘油三酯（TG）水平升高，但仍低于非 TDF 暴露组（0.26±1.24 vs. 0.89±1.78，P<0.001）。TDF 暴露组的平均估算肾小球滤过率（eGFR）从基线时的 127.29±24.04ml·min·1·73m 下降到 118.84±22.74ml·min·1·73m（P<0.001），而非 TDF 暴露组则增加。在 TDF 组中，高体重指数（BMI）（OR=1.13，P=0.01）、高基线 TG（OR=2.33，P<0.001）和接受蛋白酶抑制剂（PIs）（OR=7.58，P<0.001）与 ART 后高甘油三酯血症有关，而高基线 TCH 则预测高胆固醇血症（OR=3.58，P<0.001）。男男性接触者（MSM）（OR=0.22，P=0.02）和基线 eGFR（OR=0.90，P<0.001）与 ART 后肾功能障碍有关。
TDF 为基础的方案在中国人群中具有良好的治疗效果。与非 TDF 为基础的方案相比，该方案显示出更好的血浆脂谱，但肾功能轻度下降。使用 TDF 为基础的 ART 时，应密切监测 BMI、基线 TG、基线 TCH 和基线 eGFR 较高的患者。
