Predictors of resolution and persistence of renal laboratory abnormalities in pediatric HIV infection.
Predictors of resolution and persistence of renal laboratory abnormalities in pediatric HIV infection.
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儿科 HIV 感染中肾脏实验室异常的缓解和持续性的预测因素。
DOI：
10.1007/s00467-014-2909-1
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
IMPAACT219/219CStudyTeam
中科院分区：
文献类型：
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作者：
Mitchell,CharlesD;Chernoff,MiriamC;Seage3rd,GeorgeR;Purswani,MurliU;Spiegel,HansML;Zilleruelo,Gaston;Abitbol,Carolyn;Heckman,Barbara;Ponce,ChristopherB;Oleske,JamesM;IMPAACT219/219CStudyTeam
背景在人类免疫缺陷病毒(HIV)感染的青少年中，随着这些儿童/青少年成长为青壮年，肾脏疾病(RD)及其治疗的作用变得越来越重要。寻找肾脏实验室异常事件(RLE)的预测因素可能有助于他们的艾滋病毒感染及其相关肾脏并发症的管理。方法对HIV感染青年对≥ 48个月的随访数据进行分析，以确定RLE消退与持续的预测因素，并确定RLE对RD发病的预测作用。结果在参与研究的1874名高危儿童中，428名(23%)发生RLE，其中229名(54.0%)持续存在RLE。CD425%[危险比(HR)0.63，p<； 0.002]和艾滋病毒病毒载量为100,000拷贝/毫升(HR 0.31，p<； 0.01)的cd4百分比与降低的分离率有关，而在大多数情况下，在RLE之前或之后暴露于高效抗逆转录病毒疗法/肾毒性HAART并不相关。RLE的持续性对识别新的RD的敏感性为88%。高危人群和RLE患者RD的阴性预测值均为95%。结论晚期HIV疾病可预测HIV感染青年中RLE的持久性。持续性RLE有助于RD的鉴别。
BackgroundAmong human immunodeficiency virus (HIV)-infected youth, the role of renal disease (RD) and its management has become increasingly important as these children/adolescents mature into young adults. The identification of predictors of abnormal renal laboratory events (RLE) may be helpful in the management of their HIV infection and its associated renal complications.MethodsData collected from HIV-infected youth followed for ≥ 48 months were analyzed to identify predictors of resolution versus persistence of RLE and determine the utility of RLE to predict the onset of RD. Analysis included descriptive and inferential methods using a multivariable extended Cox proportional hazards model.ResultsOf the 1,874 at-risk children enrolled in the study, 428 (23 %) developed RLE, which persisted in 229 of these (54 %). CD4 percentages of <25 % [hazard ratio (HR) 0.63,p< 0.002) and an HIV viral load of >100,000 copies/ml (HR 0.31,p< 0.01) were associated with reduced rates of resolution, while in most cases exposure to highly active antiretroviral therapy (HAART)/nephrotoxic HAART prior to or subsequent to RLE were not. Persistence of RLE was 88 % sensitive for identifying new RD. Negative predictive values for RD were >95 % for both the at-risk cohort and those with RLE.ConclusionsAdvanced HIV disease predicted persistence of RLE in HIV-infected youth. Persistent RLE were useful for identifying RD.