Mugusi Sabina F, Shayo Grace A, Sasi Philip G, Fundikira Lulu S, Aris Eric A, Sudfeld Christopher R, Mugusi Ferdinand M
Department of Clinical Pharmacology, School of Biomedical Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America.
South Afr J HIV Med. 2025 Jan 31;26(1):1640. doi: 10.4102/sajhivmed.v26i1.1640. eCollection 2025.
Kidney disease is a growing non-AIDS-related comorbidity among people living with HIV (PLWH). Tenofovir disoproxil fumarate (TDF) can result in proximal tubulopathy and acute tubular injury, whereas atazanavir/ritonavir (ATV/r) can cause interstitial nephritis and renal stones, both of which can lead to chronic kidney disease.
To examine the relationship between second-line combination antiretroviral therapy (ART) and the risk of kidney disease and morphological changes among PLWH in Dar es Salaam, Tanzania.
A cross-sectional study of adult PLWH receiving TDF-based second-line ART. Socio-demographic and clinical data were gathered, and laboratory tests were conducted to determine the estimated glomerular filtration rate (eGFR). Ultrasonography was performed to visualise the kidneys.
A total of 323 patients were enrolled (67.8% women), with a median age of 44 (interquartile range [IQR]: 39-51) years. Patients were on second-line ART for a median of 49 [IQR: 25-73] months, and 60% received ATV/r. Low eGFR (< 90 mL/min per 1.73 m) was found in 22% of patients, proportionately higher among patients on ATV/r compared to those on a lopinavir/ritonavir (LPV/r) ( < 0.05). Nearly one-third (32.2%) of patients had a triad of renal calcinosis, renal calculi, and nephritis on ultrasonography. Patients using ATV/r had significantly smaller kidney volumes and greater proportions of renal calculi and nephritis compared to those on LPV/r ( < 0.05).
Adults on second-line ART containing TDF were found to have a high prevalence of renal kidney disease in the Tanzanian context. Predictors of kidney disease were older age, proteinuria, and ATV/r-based regimen as compared to LPV/r.
肾病是感染人类免疫缺陷病毒（HIV）的人群（PLWH）中一种日益常见的非艾滋病相关合并症。富马酸替诺福韦二吡呋酯（TDF）可导致近端肾小管病和急性肾小管损伤，而阿扎那韦/利托那韦（ATV/r）可引起间质性肾炎和肾结石，这两者均可导致慢性肾病。
研究二线联合抗逆转录病毒疗法（ART）与坦桑尼亚达累斯萨拉姆PLWH的肾病风险及形态学变化之间的关系。
对接受基于TDF的二线ART的成年PLWH进行横断面研究。收集社会人口统计学和临床数据，并进行实验室检查以确定估计肾小球滤过率（eGFR）。进行超声检查以观察肾脏。
共纳入323例患者（67.8%为女性），中位年龄为44岁（四分位间距[IQR]：39 - 51岁）。患者接受二线ART的中位时间为49[IQR：25 - 73]个月，60%接受ATV/r。22%的患者eGFR较低（<90 mL/（min·1.73 m²）），与接受洛匹那韦/利托那韦（LPV/r）的患者相比，接受ATV/r的患者中该比例更高（<0.05）。近三分之一（32.2%）的患者在超声检查中出现肾钙质沉着、肾结石和肾炎三联征。与接受LPV/r的患者相比，使用ATV/r的患者肾体积明显更小，肾结石和肾炎的比例更高（<0.05）。
在坦桑尼亚，接受含TDF的二线ART的成年人肾病患病率较高。与LPV/r相比，肾病的预测因素为年龄较大、蛋白尿和基于ATV/r的治疗方案。
