Public Health Clinical Center of Chengdu.
J Acquir Immune Defic Syndr. 2022 Oct 1;91(S1):S35-S41. doi: 10.1097/QAI.0000000000003044.
Dolutegravir (DTG) may inhibit organic cation transporter-2 in renal tubules and elevate serum creatinine levels without true renal function deterioration. There are scarce data on the glomerular filtration rate (GFR) equations in Chinese HIV patients with DTG/TDF/3 TC. This retrospective study was to evaluate the changes in creatinine- and cystatin C-based estimated GFR values among Chinese adult HIV patients with initial highly active antiretroviral therapy (HAART) with DTG/TDF/3 TC for 48 weeks.
Retrospective analysis of Chinese adult HIV patients who received initial HAART with DTG/TDF/3 TC between January 2016 and May 2021.
We compared the changes in creatinine-based and cystatin C-based estimated GFR before and 48 weeks after HAART to determine the optimal tool for renal function estimation.
Ninety-five patients [91.58% men; median age, 34 years (interquartile range, 29-44 years)] were enrolled. The median baseline CD4+ cell count was 185 cells/µL [interquartile range, 53-303 cells/µL] and the median baseline viral load was 148,000 copies/mL [interquartile range, 26,800-596,000 copies/mL]. The estimated GFR at 4, 12, and 24 weeks was significantly different than at baseline (P < 0.05) using all 4 equations. Only the GFR estimated using the CKD-EPIcreat and CKD-EPIcys equations was significantly different at 48 weeks of treatment (P < 0.05). The modification of diet in renal disease-based decline of GFR incidence at 4, 12, 24, and 48 weeks of treatment (21.5%, 24.21%, 33.68% and 38.95%, respectively) was higher than that calculated using the other 3 GFR equations.
The modification of diet in renal disease equation may not be optimal for Chinese HIV-1-infected adults receiving DTG + TDF + 3 TC as the initial antiviral therapy. Clinicians must carefully choose the GFR equation for patients with HIV/hepatitis B virus coinfection.
多拉韦林（DTG）可能会抑制肾小管中的有机阳离子转运蛋白 2，导致血清肌酐水平升高，而肾功能并未真正恶化。目前关于中国 HIV 患者使用 DTG/TDF/3TC 后基于肌酐和胱抑素 C 的肾小球滤过率（GFR）方程的数据很少。本回顾性研究旨在评估 48 周内初始高效抗逆转录病毒治疗（HAART）中使用 DTG/TDF/3TC 的中国成年 HIV 患者基于肌酐和胱抑素 C 的估算肾小球滤过率值的变化。
2016 年 1 月至 2021 年 5 月期间，接受初始 DTG/TDF/3TC 治疗的中国成年 HIV 患者的回顾性分析。
我们比较了 HAART 前后基于肌酐和胱抑素 C 的估算肾小球滤过率的变化，以确定肾功能估计的最佳工具。
共纳入 95 例患者[91.58%为男性；中位年龄 34 岁（四分位距，29-44 岁）]。中位基线 CD4+细胞计数为 185 个/µL[四分位距，53-303 个/µL]，中位基线病毒载量为 148,000 拷贝/mL[四分位距，26,800-596,000 拷贝/mL]。所有 4 个方程均显示，治疗 4、12 和 24 周时的估算肾小球滤过率与基线相比均有显著差异（P<0.05）。仅 CKD-EPIcreat 和 CKD-EPIcys 方程估算的肾小球滤过率在治疗 48 周时仍有显著差异（P<0.05）。治疗 4、12、24 和 48 周时基于改良肾脏病膳食改良公式的肾小球滤过率下降发生率（分别为 21.5%、24.21%、33.68%和 38.95%）高于其他 3 个肾小球滤过率方程。
对于初始接受 DTG+TDF+3TC 治疗的中国 HIV-1 感染成年人，改良肾脏病膳食改良公式可能不是最佳的肾小球滤过率方程。临床医生必须为 HIV/乙型肝炎病毒合并感染的患者仔细选择肾小球滤过率方程。
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