Hepatitis B and C co-infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults.
Hepatitis B and C co-infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults.
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DOI：
10.1371/journal.pone.0040245
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
ESPRIT Study Group
中科院分区：
文献类型：
--
作者：
Mocroft A;Neuhaus J;Peters L;Ryom L;Bickel M;Grint D;Koirala J;Szymczak A;Lundgren J;Ross MJ;Wyatt CM;INSIGHT SMART Study Group;ESPRIT Study Group
慢性肾病 (CKD) 是 HIV 阳性个体发病和死亡的重要原因。丙型肝炎 (HCV) 合并感染与 CKD 风险增加有关，但之前的研究缺乏潜在机制的信息。我们在 3,441 名接受抗逆转录病毒治疗的临床试验参与者中评估了 HCV 或乙型肝炎 (HBV) 合并感染与进行性 CKD 之间的关联。进行性 CKD 被定义为终末期肾病、肾死亡或肾小球滤过率 (eGFR) 显着下降（eGFR 下降 25% 至 <60 mL/min/1.73 m2 或基线 <60 下降 25%）的复合体。广义估计方程用于模拟进展性 CKD 的几率。基线时，分别有 13.8% 和 3.3% 的参与者同时感染 HCV 和 HBV。 eGFR 中位数为 111，3.7% 发展为进行性 CKD。调整后，患有 HCV（OR 1.72，95% CI 1.07–2.76）或 HBV（OR 2.26，95% CI 1.15–4.44）的参与者出现进展性 CKD 的几率增加。 HCV-RNA 检测不到或较低的参与者与 HCV 血清阴性参与者具有相似的进展性 CKD 几率，而 HCV-RNA >800,000 IU/ml 的参与者则有较高的几率（OR 3.07；95% CI 1.60-5.90）。在发生进行性 CKD 的参与者中，白介素 6、透明质酸和 FIB-4 肝纤维化指数较高，但调整后不再与进行性 CKD 相关。未来的研究应该验证 HCV 病毒血症与 CKD 之间的关系。 ClinicalTrials.gov NCT00027352； NCT00004978
Chronic kidney disease (CKD) is an important cause of morbidity and mortality in HIV-positive individuals. Hepatitis C (HCV) co-infection has been associated with increased risk of CKD, but prior studies lack information on potential mechanisms. We evaluated the association between HCV or hepatitis B (HBV) co-infection and progressive CKD among 3,441 antiretroviral-treated clinical trial participants. Progressive CKD was defined as the composite of end-stage renal disease, renal death, or significant glomerular filtration rate (eGFR) decline (25% decline to eGFR <60 mL/min/1.73 m2 or 25% decline with a baseline <60). Generalized Estimating Equations were used to model the odds of progressive CKD. At baseline, 13.8% and 3.3% of participants were co-infected with HCV and HBV, respectively. Median eGFR was 111, and 3.7% developed progressive CKD. After adjustment, the odds of progressive CKD were increased in participants with HCV (OR 1.72, 95% CI 1.07–2.76) or HBV (OR 2.26, 95% CI 1.15–4.44). Participants with undetectable or low HCV-RNA had similar odds of progressive CKD as HCV seronegative participants, while participants with HCV-RNA >800,000 IU/ml had increased odds (OR 3.07; 95% CI 1.60–5.90). Interleukin-6, hyaluronic acid, and the FIB-4 hepatic fibrosis index were higher among participants who developed progressive CKD, but were no longer associated with progressive CKD after adjustment. Future studies should validate the relationship between HCV viremia and CKD. ClinicalTrials.gov NCT00027352; NCT00004978
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