Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
School of Clinical Medicine, Jiamusi University, Jamusi, China.
HIV Med. 2021 Sep;22(8):750-758. doi: 10.1111/hiv.13123. Epub 2021 Jun 10.
People living with HIV (PLWH) have a high risk of kidney injury. Measurement of serum creatinine, along with proteinuria, is not sensitive to detect early kidney injury. Here, we investigated novel urinary biomarkers of early renal injury in PLWH.
We performed a cross-sectional study of 166 antiretroviral-naïve PLWH and 99 HIV-negative persons who all had an estimated glomerular filtration rate > 90 mL/min/1.73 m . We compared the levels of seven urinary biomarkers between the two groups using the propensity score matching (PSM) approach and explored the risk factors associated with elevated urinary biomarkers in PLWH.
Eighty-three pairs were successfully matched based on PSM. Compared with the HIV-negative group, the HIV-positive group had higher ratios of N-acetyl-β-D-glucosaminidase (NAG) to urine creatinine (UCr), alpha1-microglobulin (α1-M) to UCr, kidney injury marker-1 (KIM-1) to UCr, neutrophil gelatinase-associated lipocalin to UCr, and epidermal growth factor to UCr, whereas the Tamm-Horsfall protein to UCr ratio and the abnormal albumin to UCr ratio were not significantly different. Positive correlations were observed between HIV RNA level and NAG: UCr (r = 0.32; P < 0.001) and α1-M:UCr (r = 0.24; P = 0.002) ratios, and negative correlations were observed between CD4 cell count and NAG:UCr (r = -0.34; P < 0.001), KIM-1:UCr (r = -0.16; P = 0.042) and α1-M:UCr (r = -0.36; P < 0.001) ratios. In multivariate linear regression analyses, older age, lower total cholesterol and higher HIV RNA were independently associated with higher NAG:UCr; older age, lower total cholesterol and lower CD4 cell count were independently associated with higher α1-M:UCr.
In comparioson with HIV-negative participants, PLWH were more likely to have tubular injury. Early antiretroviral treatment might mitigate the development of kidney injury.
HIV 感染者（PLWH）发生肾脏损伤的风险较高。血清肌酐和蛋白尿的检测并不敏感，无法早期发现肾脏损伤。本研究旨在探讨 PLWH 早期肾损伤的新型尿生物标志物。
本研究为横断面研究，纳入 166 例初治抗逆转录病毒治疗的 PLWH 和 99 例 HIV 阴性者，所有参与者的估计肾小球滤过率均大于 90ml/min/1.73m 。采用倾向评分匹配（PSM）比较两组间 7 种尿生物标志物的水平，并探讨 PLWH 中与尿生物标志物升高相关的危险因素。
基于 PSM 成功匹配了 83 对。与 HIV 阴性组相比，HIV 阳性组的 N-乙酰-β-D-氨基葡萄糖苷酶（NAG）与尿肌酐（UCr）比值、α1-微球蛋白（α1-M）与 UCr 比值、肾损伤标志物 1（KIM-1）与 UCr 比值、中性粒细胞明胶酶相关脂质运载蛋白与 UCr 比值和表皮生长因子与 UCr 比值均较高，而 Tamm-Horsfall 蛋白与 UCr 比值和异常白蛋白与 UCr 比值无显著差异。HIV RNA 水平与 NAG:UCr（r=0.32；P<0.001）和 α1-M:UCr（r=0.24；P=0.002）比值呈正相关，与 CD4 细胞计数呈负相关，与 NAG:UCr（r=-0.34；P<0.001）、KIM-1:UCr（r=-0.16；P=0.042）和 α1-M:UCr（r=-0.36；P<0.001）比值呈负相关。多变量线性回归分析显示，年龄较大、总胆固醇较低和 HIV RNA 较高与 NAG:UCr 比值较高独立相关；年龄较大、总胆固醇较低和 CD4 细胞计数较低与 α1-M:UCr 比值较高独立相关。
与 HIV 阴性参与者相比，PLWH 更易发生肾小管损伤。早期抗逆转录病毒治疗可能减轻肾脏损伤的发生。
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