School of Pharmacy, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe.
Newlands Clinic, Highlands, Harare, Zimbabwe.
PLoS One. 2021 Feb 24;16(2):e0245383. doi: 10.1371/journal.pone.0245383. eCollection 2021.
There is a potential increase in risk of renal function impairment among patients with invasive cervical cancer (ICC) who are HIV-positive and treated with cisplatin-based concurrent chemoradiation (CCRT). This concern is due to overlapping nephrotoxicity of the drugs, and nephropathy from the diseases themselves. There is limited literature available for the short-term renal outcomes for HIV-positive patients with ICC during routine clinical management. This study aimed to assess if HIV-infection increased the risk of renal impairment in ICC patients treated with CCRT, and explore the respective risk factors.
This was a retrospective review of records of ICC patients treated with at least one cycle of weekly cisplatin during CCRT at the Parirenyatwa Radiotherapy Center from January 2017-December 2018. The RIFLE criteria were used to classify renal impairment. Analyses were performed with Fisher's Exact tests, Wilcoxon rank sum tests. Odds ratios (OR) were generated using logistic regression. All statistical tests were 2-sided at a 5% level of significance.
Seventy-two eligible patients were identified, 32 (44.44%) were HIV-positive. HIV-positive patients were younger (p = 0.002), had lower albumin levels (p = 0.014) and received lower cisplatin doses (p = 0.044). The mean percent reduction in estimated glomerular filtration rate (eGFR) from baseline was -19% (95% CI: -25.9% to -13.2%) for all patients. Thirty-one (43.1%) patients experienced renal impairment, 50% and 37.5% of HIV-positive and -negative patients respectively (p = 0.287). HIV-infection was associated with an adjusted OR of 1.16 (95% CI 0.35-3.43, p = 0.769). Baseline eGFR< 60ml/min was the only independent predictor of renal impairment, OR 0.25 (95% CI: 0.07-0.85). Baseline eGFR<60ml/min was also associated with receipt of lower cisplatin doses (p = 0.044).
HIV-infection was not associated with elevated risk of renal impairment. Patients with an eGFR<60ml/min appear to be managed more cautiously reducing their risk for renal impairment during cisplatin therapy. The high prevalence of renal impairment in this population suggests the need for optimization of pre-treatment protocols.
患有侵袭性宫颈癌（ICC）且接受顺铂为基础的同期放化疗（CCRT）的 HIV 阳性患者，其肾功能损害风险可能会增加。这是由于药物的肾毒性重叠，以及疾病本身导致的肾病。对于 HIV 阳性 ICC 患者在常规临床管理中的短期肾功能结局，相关文献有限。本研究旨在评估 HIV 感染是否会增加接受 CCRT 治疗的 ICC 患者的肾功能损害风险，并探讨各自的危险因素。
这是对 2017 年 1 月至 2018 年 12 月在 Parirenyatwa 放射治疗中心接受至少一个周期每周顺铂治疗的 ICC 患者的记录进行的回顾性分析。使用 RIFLE 标准对肾功能损害进行分类。使用 Fisher 精确检验、Wilcoxon 秩和检验进行分析。使用逻辑回归生成比值比（OR）。所有统计检验均在 5%水平上进行双侧检验。
确定了 72 名符合条件的患者，其中 32 名（44.44%）为 HIV 阳性。HIV 阳性患者更年轻（p = 0.002），白蛋白水平更低（p = 0.014），顺铂剂量更低（p = 0.044）。所有患者的估计肾小球滤过率（eGFR）基线降低的平均百分比为-19%（95%CI：-25.9%至-13.2%）。31 名（43.1%）患者发生肾功能损害，HIV 阳性和阴性患者分别为 50%和 37.5%（p = 0.287）。HIV 感染与调整后的 OR 为 1.16（95%CI 0.35-3.43，p = 0.769）相关。基线 eGFR<60ml/min 是肾功能损害的唯一独立预测因素，OR 0.25（95%CI：0.07-0.85）。基线 eGFR<60ml/min 也与顺铂剂量较低有关（p = 0.044）。
HIV 感染与肾功能损害风险增加无关。基线 eGFR<60ml/min 的患者在接受顺铂治疗时似乎更谨慎，降低了肾功能损害的风险。该人群中肾功能损害的高患病率表明需要优化治疗前方案。
