Hepatitis C Virus Increases the Risk of Kidney Disease Among HIV-Positive Patients: Systematic Review and Meta-Analysis
Hepatitis C Virus Increases the Risk of Kidney Disease Among HIV-Positive Patients: Systematic Review and Meta-Analysis
复制标题
DOI：
10.1002/jmv.24353
复制
发表时间：
2016-03-01
影响因子：
12.7
通讯作者：
Messa，Piergiorgio
中科院分区：
文献类型：
--
作者：
Fabrizi，Fabrizio;Dixit，Vivek;Messa，Piergiorgio
在高效抗逆转录病毒治疗的时代，肾脏疾病已成为人类免疫缺陷病毒感染患者的重要并发症，因为他们的寿命更长。目前尚不清楚丙型肝炎病毒合并感染如何影响HIV感染患者肾脏疾病的发展轨迹。评估丙型肝炎病毒合并感染对HIV感染人群肾脏疾病风险的影响。我们对已发表的医学文献进行了系统回顾，以确定丙型肝炎合并感染是否与HIV阳性成人患慢性肾脏疾病的可能性增加有关。我们使用DerSimonian和Laird的随机效应模型对已发表的研究中丙型肝炎病毒感染慢性肾脏疾病（由肾小球滤过率降低和/或可检测蛋白尿定义）的相对风险进行了汇总估计。还进行了Meta回归和分层分析。我们确定了19项研究（146151名独特的HIV患者），并根据结果进行了单独的meta分析。纵向研究汇总（n= 8,105,462例独特患者）显示，在HIV感染者中，HCV感染与肾小球滤过率降低的风险增加之间存在关系，与HIV单感染患者相比，HIV - HCV共感染患者的调整后风险比的总估计为1.64 （95%CI, 1.28; 2.0，P< 0.001）。研究间未发现异质性（qtest P值= 0.08）。HCV血清学阳性是蛋白尿的独立危险因素；调整后的效应估计为1.23(95%可信区间为1.18;1.28，P= 0.001) （n= 6项研究；26,835例独特患者）。在meta回归中，我们注意到年龄对HCV - HIV共感染患者肾小球滤过率降低发生率的调整风险比的影响（P= 0.0001）；男性发病频率与肾小球滤过率低患病率的校正风险比呈负相关（P= 0.001）。丙型肝炎合并感染与HIV感染者肾小球滤过率降低和/或可检测蛋白尿的风险显著增加相关。中华医学杂志，2016,33(4):487 - 497。©2015 Wiley期刊公司
Kidney disease has become an important co‐morbidity among human immunodeficiency virus‐infected patients as they live longer in the era of highly effective antiretroviral therapy. It remains unclear how co‐infection with hepatitis C virus impacts on the trajectory of kidney disease among HIV‐infected patients. To evaluate the effect of co‐infection with HCV on the risk of kidney disease in HIV‐infected populations. We conducted a systematic review of the published medical literature to determine if hepatitis C co‐infection is associated with increased likelihood of chronic kidney disease in HIV‐positive adults. We used the random effects model of DerSimonian and Laird to generate a summary estimate of the relative risk for chronic kidney disease (defined by reduced glomerular filtration rate and/or detectable proteinuria) with hepatitis C virus across the published studies. Meta‐regression and stratified analysis were also conducted. We identified 19 studies (146,151 unique patients with HIV) and separate meta‐analyses were performed according to the outcome. Aggregation of longitudinal studies (n= 8, 105,462 unique patients) showed a relationship between HCV infection and increased risk of reduced glomerular filtration rate among HIV‐infected individuals, the summary estimate for adjusted hazard ratio was 1.64 (95%CI, 1.28; 2.0,P< 0.001) in HIV‐HCV co‐infected individuals compared with those having HIV mono‐infection. No between‐studies heterogeneity was noted (P‐value byQtest = 0.08). HCV positive serology was an independent risk factor for proteinuria; adjusted effect estimate, 1.23 (95% confidence interval, 1.18; 1.28,P= 0.001) (n= 6 studies; 26,835 unique patients). In meta‐regression, we noted the impact of ageing (P= 0.0001) upon the adjusted hazard ratio of incidence of reduced glomerular filtration rate among HCV‐HIV co‐infected patients; a negative association between frequency of males (P= 0.001) and the adjusted hazard ratio of prevalence of low glomerular filtration rate was found. Hepatitis C co‐infection is associated with a significant increase in the risk of reduced glomerular filtration rate and/or detectable proteinuria among HIV‐infected individuals.J. Med. Virol. 88:487–497, 2016.© 2015 Wiley Periodicals, Inc.