与高血压患者和非高血压患者抗逆转录病毒治疗毒性结局相关的因素。
Factors Associated with Antiretroviral Therapy Toxicity Out-Comes in Patients with and without Hypertension.
机构信息
Department of Public Health, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
出版信息
Int J Environ Res Public Health. 2022 Sep 3;19(17):11051. doi: 10.3390/ijerph191711051.
BACKGROUND
Negative effects of antiretroviral therapy (ART) drugs on HIV/AIDS patients are one of the major health issues in the therapeutic treatment of this communicable disease. This holds particularly for people living with HIV (PLHIV) who might have a non-communicable disease (like hypertension), which also requires a lifetime treatment. In this study, we investigated the association between hypertension and other possible factors on ART toxicity markers in patients with hypertension, compared to those without hypertension.
METHODS
This retrospective longitudinal study reviewed chronic patient files of 525 patients (of which 222 were hypertensive) who satisfied the inclusion criteria and were on ART at a hospital in central Eswatini. Specific levels of estimated glomerular filtration (eGFR), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were used as drug toxicity markers. To analyze the longitudinal data between the exposure of interest and outcome variables, a Generalized Estimated Equation method was employed.
RESULTS
Participants with hypertension had decreased eGFR compared to those without hypertension (β = -2.22; -value = 0.03). There was no significant association between ALT, AST and hypertension (-value = 0.34 and 0.20, respectively). Factors that were found to have a significant association with ART toxicity markers included age, sex, ART duration, hypertension treatment and time of study. The eGFR was found to be significantly increasing over the study period (-value < 0.001) for all participants. The significance was consistent in both hypertensive and non-hypertensive participants independently (-value = 0.002 and <0.001, respectively). The overall trends of ALT and AST over time were also significant (-value = 0.003 and <0.001, respectively).
CONCLUSIONS
Patients with hypertension had decreased eGFR, and there was a significant association of eGFR with time of the study. Special attention, therefore, to monitor calamities which are indicated by a decrease of eGFR (like renal impairment) should be given in PLHIV on ART with hypertension, especially more so if they were on ART for longer time.
背景
抗逆转录病毒疗法（ART）药物对艾滋病毒/艾滋病患者的负面影响是这种传染病治疗中的主要健康问题之一。对于可能患有非传染性疾病（如高血压）的艾滋病毒感染者（PLHIV）来说尤其如此，这种疾病也需要终身治疗。在这项研究中，我们调查了高血压患者与非高血压患者相比，高血压与其他可能导致 ART 毒性标志物的因素之间的关联。
方法
这项回顾性纵向研究回顾了 525 名符合纳入标准且正在斯威士兰中部一家医院接受 ART 治疗的慢性患者档案（其中 222 名患有高血压）。特定水平的估算肾小球滤过率（eGFR）、丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）被用作药物毒性标志物。为了分析暴露于感兴趣的因素和结果变量之间的纵向数据，使用了广义估计方程方法。
结果
与非高血压患者相比，高血压患者的 eGFR 降低（β=-2.22；-值=0.03）。ALT、AST 与高血压之间没有显著关联（-值分别为 0.34 和 0.20）。与 ART 毒性标志物有显著关联的因素包括年龄、性别、ART 持续时间、高血压治疗和研究时间。研究期间，所有参与者的 eGFR 均呈显著增加趋势（-值<0.001）。在高血压和非高血压参与者中，这一趋势均具有统计学意义（-值分别为 0.002 和<0.001）。ALT 和 AST 随时间的总体趋势也具有统计学意义（-值分别为 0.003 和<0.001）。
结论
高血压患者的 eGFR 降低，并且 eGFR 与研究时间之间存在显著关联。因此，在接受 ART 的高血压 PLHIV 中，应特别注意监测 eGFR 下降（如肾功能损害）所提示的不良事件，尤其是如果他们接受 ART 的时间更长。
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