Long Term Exposure to Tenofovir Disoproxil Fumarate-Containing Antiretroviral Therapy Is Associated with Renal Impairment in an African Cohort of HIV-Infected Adults
Long Term Exposure to Tenofovir Disoproxil Fumarate-Containing Antiretroviral Therapy Is Associated with Renal Impairment in an African Cohort of HIV-Infected Adults
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DOI：
10.1177/2325958218821963
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Kanki, Phyllis J.
中科院分区：
文献类型：
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作者：
Agbaji, Oche O.;Abah, Isaac O.;Kanki, Phyllis J.
目的和方法：人们越来越关注富马酸替诺福韦二吡呋酯 (TDF) 相关的肾毒性。我们评估了 2006 年至 2015 年间感染 HIV-1 的尼日利亚人队列中长期 TDF 暴露对肾功能的影响。使用多变量逻辑回归来确定抗逆转录病毒治疗 (ART) 144 周内不同时间肾功能损害的预测因素。结果：分析了 4897 名患者的数据，中位年龄 42 岁（四分位距：36-49），其中 61% 为女性。暴露于 TDF 的参与者的肾功能损害患病率从第 24 周时的 10% 上升至 144 周时的 45%，而未暴露于 TDF 的参与者中肾损害的患病率从 24 周时的 8% 上升至 144 周时的 14%。富马酸替诺福韦二吡呋酯暴露可预测 ART 144 周时出现肾损伤的风险（比值比：2.36；95% 置信区间：1.28-4.34）。 结论：长期暴露于基于 TDF 的 ART 显着增加肾损伤的可能性。应审查在我们的环境中继续使用基于 TDF 的方案。我们建议在尼日利亚和其他资源有限国家的艾滋病毒治疗指南中紧急引入基于替诺福韦艾拉酚胺的治疗方案。
Objectives and Method: There are growing concerns of tenofovir disoproxil fumarate (TDF)-associated renal toxicity. We evaluated the effect of long-term TDF exposure on renal function in a cohort of HIV-1-infected Nigerians between 2006 and 2015. Multivariate logistic regression was used to identify predictors of renal impairment at different time over 144 weeks of antiretroviral therapy (ART).Results: Data of 4897 patients, median age 42 years (interquartile range: 36-49), and 61% females were analyzed. The prevalence of renal impairment increased from 10% at week 24 to 45% at 144 weeks in TDF-exposed participants compared to an increase from 8% at 24 weeks to 14% at 144 weeks in TDF-unexposed participants. Tenofovir disoproxil fumarate exposure predicted the risk of renal impairment at 144 weeks of ART (odds ratio: 2.36; 95% confidence interval: 1.28-4.34).Conclusion: Long-term exposure to TDF-based ART significantly increases the likelihood of renal impairment. The continued use of TDF-based regimen in our setting should be reviewed. We recommend the urgent introduction of tenofovir alafenamide-based regimen in the HIV treatment guidelines of Nigeria and other resource-limited countries.