Reduced renal function is associated with progression to AIDS but not with overall mortality in HIV-infected Kenyan adults not initially requiring combination antiretroviral therapy.
Reduced renal function is associated with progression to AIDS but not with overall mortality in HIV-infected Kenyan adults not initially requiring combination antiretroviral therapy.
复制标题
DOI：
10.1186/1758-2652-14-31
复制
发表时间：
2011-06-11
影响因子：
6
通讯作者：
Wools-Kaloustian K
中科院分区：
文献类型：
--
作者：
Gupta SK;Ong'or WO;Shen C;Musick B;Goldman M;Wools-Kaloustian K
世界卫生组织（WHO）最近建议，抗逆转录病毒药物开始在所有个人与CD 4计数低于350细胞/mm 3。对于资源过于有限而无法扩大对所有此类患者的护理的国家来说，能够确定和针对艾滋病毒进展风险最高的人群将是有价值的。在某些人群中，肾脏疾病已被确定为疾病进展或死亡的风险因素。在CD 4细胞计数≥ 200/mm 3和WHO 1或2期疾病的cART初治、HIV感染的肯尼亚成人中评价达到联合抗逆转录病毒治疗（cART）启动标准（发展为CD 4计数<200个细胞/mm 3或WHO 3或4期疾病）的时间和总体死亡率。使用考克斯比例风险回归模型评价肾功能与这些终点之间的相关性。我们分析了7383例受试者的数据，中位随访时间为59周（四分位距，27-97）。在校正了年龄、性别、WHO疾病分期、CD 4细胞计数和血红蛋白的考克斯回归分析中，估计肌酐清除率（CrCl）< 60 mL/min与达到cART启动标准的时间较短显著相关（HR 1.34; 95% CI，1.23-1.52）和总体死亡率（人力资源1.73; 95%可信区间，1.19-2.51）与CrCl ≥60 mL/min相比。估计肾小球滤过率（eGFR）< 60 mL/min/1.73 m2与达到cART启动标准的时间较短相关（HR 1.39; 95% CI，1.22-1.58），但与总体死亡率无关。在体重调整分析中，CrCl和eGFR与达到cART启动标准的时间较短相关，但与死亡率均无关。在这项大型自然史研究中，肾功能下降与最初不符合cART启动标准的肯尼亚成年人的HIV疾病进展加快密切相关。因此，在资源有限的情况下，肾功能测量可能是一种廉价的方法，以确定那些最需要的cART，以防止进展为艾滋病。CrCl降低（而不是eGFR降低）与死亡率升高之间的初始相关性可通过该人群中的低体重来解释。
The World Health Organization (WHO) has recently recommended that antiretrovirals be initiated in all individuals with CD4 counts of less than 350 cells/mm3. For countries with resources too limited to expand care to all such patients, it would be of value to able to identify and target populations at highest risk of HIV progression. Renal disease has been identified as a risk factor for disease progression or death in some populations. Times to meeting combination antiretroviral therapy (cART) initiation criteria (developing either a CD4 count < 200 cells/mm3 or WHO stage 3 or 4 disease) and overall mortality were evaluated in cART-naïve, HIV-infected Kenyan adults with CD4 cell counts ≥200/mm3 and with WHO stage 1 or 2 disease. Cox proportional hazard regression models were used to evaluate the associations between renal function and these endpoints. We analyzed data of 7383 subjects with a median follow-up time of 59 (interquartile range, 27-97) weeks. In Cox regression analyses adjusted for age, sex, WHO disease stage, CD4 cell count and haemoglobin, estimated creatinine clearance (CrCl) < 60 mL/min was significantly associated with shorter times to meeting cART initiation criteria (HR 1.34; 95% CI, 1.23-1.52) and overall mortality (HR 1.73; 95% CI, 1.19-2.51) compared with CrCl ≥60 mL/min. Estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 was associated with shorter times to meeting cART initiation criteria (HR 1.39; 95% CI, 1.22-1.58), but not with overall mortality. CrCl and eGFR remained associated with shorter times to cART initiation criteria, but neither was associated with mortality, in weight-adjusted analyses. In this large natural history study, reduced renal function was strongly associated with faster HIV disease progression in adult Kenyans not initially meeting cART initiation criteria. As such, renal function measurement in resource-limited settings may be an inexpensive method to identify those most in need of cART to prevent progression to AIDS. The initial association between reduced CrCl, but not reduced eGFR, and greater mortality was explained by the low weights in this population.
登录
查看更多内容
影响因子：
3.8
作者：
Wools-Kaloustian, K;Kimaiyo, S;Tierney, WM
通讯作者：
Tierney, WM
DOI：
10.1097/qai.0b013e3181b843f0
发表时间：
2010-03
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Geng EH;Bangsberg DR;Musinguzi N;Emenyonu N;Bwana MB;Yiannoutsos CT;Glidden DV;Deeks SG;Martin JN
通讯作者：
Martin JN
影响因子：
39.2
作者：
Mellors, JW;Munoz, A;Rinaldo, CR
通讯作者：
Rinaldo, CR
影响因子：
6.1
作者：
Stam, F;van Guldener, C;Stehouwer, CDA
通讯作者：
Stehouwer, CDA
影响因子：
168.9
作者：
Morgan, D;Maude, GH;Whitworth, JA
通讯作者：
Whitworth, JA