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首页> 外文期刊>AIDS >Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir.
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Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir.

机译：替诺福韦治疗艾滋病毒成人肾功能不全，肾毒性和死亡之间的关系。

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OBJECTIVE: In April 2010, the South African government added tenofovir disoproxil fumarate to its first-line antiretroviral therapy (ART) for HIV patients. We analyzed the relationship between renal dysfunction at tenofovir initiation, nephrotoxicity and mortality. DESIGN: Cohort analysis of HIV-infected adults who received tenofovir and had a creatinine clearance done at initiation at the Themba Lethu Clinic, Johannesburg, South Africa, between April 2004 and September 2009. METHODS: We estimated the relationship between renal dysfunction, nephrotoxicity [any decline in kidney function from baseline (acute or chronic) that is secondary to a toxin (including drugs)] and mortality for patients initiated onto tenofovir-containing regimens using marginal structural models and inverse probability of treatment weights to correct estimates for lost to follow-up and confounding. RESULTS: Of 890 patients initiated onto tenofovir, 573 (64.4%) had normal renal function (>/=90 ml/min), 271 (30.4%) had mild renal dysfunction (60-89 ml/min) and 46 (5.2%) had moderate renal dysfunction (30-59 ml/min). A total of 2.4% experienced nephrotoxicity, 7.8% died and 9.7% were lost during 48 months of follow-up. Patients with mild [hazard ratio 4.8; 95% confidence interval (CI) 1.5-15.2] or moderate (hazard ratio 15.0; 95% CI 3.4-66.5) renal dysfunction were at greatest risk of nephrotoxicity, whereas those with mild (hazard ratio 1.2; 95% CI 0.7-2.3) or moderate (hazard ratio 3.2; 95% CI 1.3-7.8) renal dysfunction vs. normal renal function were at highest risk of death by 48 months. CONCLUSION: Much of the incident renal dysfunction in tenofovir patients is likely related to preexisting renal disorder, which may be exacerbated by tenofovir. With expanded use of tenofovir, screening for renal dysfunction prior to initiation and dose adjustment is necessary to help improve ART outcomes.
机译：目的：2010年4月，南非政府在针对艾滋病毒患者的一线抗逆转录病毒疗法（ART）中增加了富马酸替诺福韦酯（disoproxil fumarate）。我们分析了替诺福韦起始时肾功能不全，肾毒性和死亡率之间的关系。设计：2004年4月至2009年9月，在南非约翰内斯堡Themba Lethu诊所接受HIV感染的成人接受Tenofovir并在开始时进行肌酐清除的人群的队列分析。方法：我们估计了肾功能不全与肾毒性之间的关系[毒素（包括药物）之后继发于基线（急性或慢性）的肾功能的任何下降]和采用边缘结构模型和治疗权重的反概率校正含替诺福韦治疗方案的患者的死亡率，以纠正后续损失和混淆。结果：在890名开始使用替诺福韦治疗的患者中，有573名（64.4％）肾功能正常（> / = 90 ml / min），271名（30.4％）有轻度肾功能不全（60-89 ml / min）和46名（5.2％） ）有中度肾功能不全（30-59 ml / min）。在48个月的随访中，共有2.4％发生肾毒性，死亡7.8％，丢失9.7％。轻度[危险比4.8; 95％置信区间（CI）1.5-15.2]或中度（危险比15.0; 95％CI 3.4-66.5）肾功能不全的肾毒性风险最大，而轻度者（危险比1.2; 95％CI 0.7-2.3）在48个月内，中度或中度（危险比3.2; 95％CI 1.3-7.8）肾功能不全与正常肾功能的死亡风险最高。结论：替诺福韦患者的大部分肾功能不全可能与既往存在的肾脏疾病有关，替诺福韦可能加剧了这种疾病。随着替诺福韦的广泛使用，有必要在开始和剂量调整之前筛查肾功能不全，以帮助改善抗逆转录病毒疗法的疗效。

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