Increased risk of abnormal proximal renal tubular function with HIV infection and antiretroviral therapy
Increased risk of abnormal proximal renal tubular function with HIV infection and antiretroviral therapy
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DOI：
10.1038/ki.2011.124
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发表时间：
2011-08-01
影响因子：
19.6
通讯作者：
Dupon, Michel
中科院分区：
文献类型：
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作者：
Dauchy, Frederic-Antoine;Lawson-Ayayi, Sylvie;Dupon, Michel
肾功能异常是人类免疫缺陷病毒（HIV）感染过程中常见的。在此，我们对阿基坦队列（一个接受常规临床管理的HIV-1感染患者的医院队列）中的399例患者进行了横断面分析，以估计与HIV感染相关的近端肾小管功能障碍（PRTD）的患病率。这些患者在社会人口统计学、中位年龄、自HIV诊断以来的年数、AIDS分期或中位CD 4细胞计数方面与整个3080例患者队列无统计学差异。352名患者接受了抗逆转录病毒治疗，其中256名患者接受了替诺福韦（TDF）治疗; 325名患者的HIV血浆病毒载量检测不到，26名患者被诊断为PRTD。在多变量分析中，发现PRTD与年龄（每5年增加的比值比（OR）为1.28）、阿扎那韦（每年暴露的OR为1.28）和TDF（每年暴露的OR为1.23）治疗之间存在显著的独立相关性。在接受含TDF方案治疗超过5年的患者中，当治疗正在进行（OR 5.22）或已停止（OR 11.49）时，PRTD仍与TDF暴露显著相关。因此，TDF和/或阿扎那韦的累积暴露与PRTD风险增加相关，并关注其在HIV患者中的可逆性。
Abnormal kidney function is common in the course of human immunodeficiency virus (HIV) infection. Here, we performed a cross-sectional analysis using 399 patients within the Aquitaine cohort (a hospital-based cohort of HIV-1-infected patients receiving routine clinical management) to estimate the prevalence of proximal renal tubular dysfunction (PRTD) associated with HIV infection. These patients did not differ statistically by sociodemographics, median age, years since HIV diagnosis, AIDS stage, or median CD4 cell count from the entire 3080 patient cohort. Antiretroviral therapy was received by 352 patients, with 256 given tenofovir (TDF); 325 had undetectable HIV plasma viral load, and 26 were diagnosed with PRTD. In multivariate analysis, significant independent associations were found between PRTD and age (odds ratio (OR) 1.28 per 5-year increase), atazanavir (OR 1.28 per year of exposure), and TDF (OR 1.23 per year) treatment. Among patients having received TDF-containing regimens over a 5-year period, PRTD remained significantly associated with TDF exposure when treatment was ongoing (OR 5.22) or had been discontinued (OR 11.49). Thus, cumulative exposure to TDF and/or atazanavir was associated with an increased risk of PRTD, with concern about its reversibility in patients with HIV.