在津巴布韦，对开始接受抗逆转录病毒治疗的未接受过治疗的感染艾滋病毒青少年进行肾功能损害评估。

Assessing renal impairment in treatment-naïve adolescents living with HIV commencing antiretroviral therapy in Zimbabwe.

作者信息

Byers Bradley W, Drak Douglas, Shamu Tinei, Chimbetete Cleophas, Dahwa Rumbidzai, Gracey David M

机构信息

Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney.

Royal North Shore Hospital, St Leonards.

出版信息

AIDS. 2023 Apr 1;37(5):789-794. doi: 10.1097/QAD.0000000000003482. Epub 2023 Jan 13.

DOI:10.1097/QAD.0000000000003482

PMID:36728249

Abstract

OBJECTIVE

People with HIV (PWH) are increasingly experiencing non-communicable complications, including renal impairment, which are associated with worse clinical outcomes. Limited information exists surrounding renal impairment in paediatric PWH, of which the majority live in sub-Saharan Africa, and further information is required to guide clinical practice. This study describes the prevalence of new or worsening renal impairment in adolescents commencing antiretroviral therapy (ART) in Zimbabwe and associated risk factors.

DESIGN

Retrospective cohort study.

METHODS

Data were collected between January 2010 to January 2019 from the medical records of adolescents aged 12-17 years initiating ART at an outpatient HIV clinic in Zimbabwe. Renal function (estimated glomerular filtration rate, eGFR) was calculated using the Full Age Spectrum formula. Proteinuria was defined as a single urine dipstick score of ≥1+. Potential predictors of renal impairment at follow-up were assessed by logistical regression.

RESULTS

Two hundred and sixty-six adolescents were included in analysis. Baseline renal impairment (eGFR < 90 ml/min/1.73 m 2 ) and proteinuria were present in 13% and 7% of the cohort, respectively. After a median of 4.1 years (interquartile range: 1.9-6.9) following ART commencement, mean eGFR increased by 10 ml/min/1.73 m 2 ( P < 0.01), and the prevalence of renal impairment decreased to 8% ( P < 0.01). Baseline renal impairment predicted renal impairment at follow-up (odds ratio [OR] 8.98; 95% confidence interval [CI] 2.81-28.68; P < 0.01). Proteinuria trended towards association with renal impairment at follow-up (OR 4.39; 95% CI 0.95-20.31; P = 0.06).

CONCLUSIONS

Renal impairment is common in adolescent ART-naïve PWH, and baseline renal impairment is associated with longstanding renal impairment, whereas baseline proteinuria trended towards an association with longstanding renal impairment.

摘要

目的

感染艾滋病毒的人（PWH）越来越多地出现非传染性并发症，包括肾功能损害，这与更差的临床结果相关。关于儿科PWH肾功能损害的信息有限，其中大多数生活在撒哈拉以南非洲，需要更多信息来指导临床实践。本研究描述了在津巴布韦开始接受抗逆转录病毒治疗（ART）的青少年中新发或恶化的肾功能损害的患病率及相关危险因素。

设计

回顾性队列研究。

方法

收集2010年1月至2019年1月期间在津巴布韦一家门诊艾滋病毒诊所开始接受ART治疗的12 - 17岁青少年的医疗记录数据。使用全年龄谱公式计算肾功能（估计肾小球滤过率，eGFR）。蛋白尿定义为单次尿试纸条评分≥1 +。通过逻辑回归评估随访时肾功能损害的潜在预测因素。

结果

266名青少年纳入分析。队列中分别有13%和7%的人存在基线肾功能损害（eGFR < 90 ml/min/1.73 m²）和蛋白尿。在开始ART治疗后的中位时间4.1年（四分位间距：1.9 - 6.9），平均eGFR增加了10 ml/min/1.73 m²（P < 0.01），肾功能损害的患病率降至8%（P < 0.01）。基线肾功能损害可预测随访时的肾功能损害（比值比[OR] 8.98；95%置信区间[CI] 2.81 - 28.68；P < 0.01）。蛋白尿在随访时与肾功能损害有相关趋势（OR 4.39；95% CI 0.95 - 20.31；P = 0.06）。