Doshi Saumil, Ucanda Martin, Hart Rachel, Hou Qingjiang, Terzian Arpi S
Section of Infectious Diseases, MedStar Washington Hospital Center, Washington, DC, USA.
Division of Infectious Diseases, Howard University Hospital, Washington, DC, USA.
Kidney Int Rep. 2019 May 7;4(8):1075-1084. doi: 10.1016/j.ekir.2019.04.024. eCollection 2019 Aug.
Prior studies found renal disease was common among HIV-infected outpatients. We updated incident renal disease estimates in this population, comparing those with and without tenofovir exposure.
We conducted a retrospective analysis of the DC Cohort, a longitudinal study of HIV patients in Washington, DC, from 2011 to 2015. We included adults prescribed antiretroviral therapy (ART) with baseline glomerular filtration rate (GFR) ≥15 ml/min per 1.73 m. We defined renal disease as 50% decrease in GFR or doubled serum creatinine (Cr) within 3 months. We defined cumulative viral load as area under the curve (AUC) of log transformed longitudinal HIV RNA viral load (VL). Correlates of time to incident renal disease were identified using Cox proportional hazard regression models, adjusted for demographics and known risk factors for kidney disease.
Among 6068 adults, 77% were Black and median age was 48 years. Incident renal disease rate was 0.77 per 100 person-years (95% confidence interval [CI]: 0.65-0.9). Factors associated with renal disease were age (adjusted hazard ratio [aHR]: 1.4; CI 1.1-1.7 per 10 years), public non-Medicaid, non-Medicare insurance (aHR: 3.4; CI: 1.9-6.4), AUC VL (aHR: 1.1; CI: 1.1-1.2), diabetes mellitus (aHR: 1.6; CI: 1.0-2.4), and mildly reduced GFR (60-89 ml/min per 1.73 m) (aHR: 1.5; CI: 1.0-2.3); recent tenofovir exposure was not associated with renal disease (aHR: 0.7; CI: 0.5-1.1).
Our study revealed a substantial burden of renal disease among HIV patients. Cumulative VL was associated with renal disease, suggesting that early VL suppression may decrease its incidence.
先前的研究发现，肾病在感染HIV的门诊患者中很常见。我们更新了该人群中新发肾病的估计数据，比较了使用和未使用替诺福韦的患者。
我们对华盛顿特区的HIV患者进行了一项纵向研究——DC队列研究，时间跨度为2011年至2015年。我们纳入了接受抗逆转录病毒治疗（ART）且基线肾小球滤过率（GFR）≥15 ml/min/1.73 m²的成年人。我们将肾病定义为GFR在3个月内下降50%或血清肌酐（Cr）翻倍。我们将累积病毒载量定义为对数转换后的纵向HIV RNA病毒载量（VL）曲线下面积（AUC）。使用Cox比例风险回归模型确定新发肾病发生时间的相关因素，并对人口统计学和已知的肾脏疾病风险因素进行了调整。
在6068名成年人中，77%为黑人，中位年龄为48岁。新发肾病发生率为每100人年0.77例（95%置信区间[CI]：0.65 - 0.9）。与肾病相关的因素包括年龄（调整后风险比[aHR]：1.4；每10年CI 1.1 - 1.7）、公共非医疗补助、非医疗保险（aHR：3.4；CI：1.9 - 6.4）、AUC VL（aHR：1.1；CI：1.1 - 1.2）、糖尿病（aHR：1.6；CI：1.0 - 2.4）以及轻度降低的GFR（60 - 89 ml/min/1.73 m²）（aHR：1.5；CI：1.0 - 2.3）；近期使用替诺福韦与肾病无关（aHR：0.7；CI：0.5 - 1.1）。
我们的研究揭示了HIV患者中肾病的沉重负担。累积VL与肾病相关，这表明早期抑制VL可能会降低其发病率。
