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首页> 外文期刊>Infectious disorders drug targets >Effects of Highly Active Antiretroviral Therapy on Renal Function and Renal Phosphate Handling in African Adults with Advanced HIV and CKD
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Effects of Highly Active Antiretroviral Therapy on Renal Function and Renal Phosphate Handling in African Adults with Advanced HIV and CKD

机译：Effects of Highly Active Antiretroviral Therapy on Renal Function and Renal Phosphate Handling in African Adults with Advanced HIV and CKD

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Background: Highly Active Antiretroviral Therapy (HAART) has been implicatedin renal dysfunction with hypophosphataemia.Objective: We prospectively evaluated renal phosphate excretion during HAART use.Method: Newly diagnosed human immunodeficiency virus (HIV)-infected individualswere treated with Tenofovir disoproxil fumarate/Emtricitabine/Efavirenz(TDF/FTC/EFV), n=33; Zidovudine/Lamivudine/Nevirapine (ZDV/3TC/NVP), n=53;and Zidovudine/Lamivudine/Efavirenz (ZDV/3TC/EFV), n=16. Creatinine and phosphatewere assayed in blood and urine simultaneously at baseline, 1, 3, 6 and 9 months.Glomerular filtration rate (eGFR), fractional phosphate excretion and reabsorption(FEPi % and TRP), and the ratio of tubular maximum reabsorption of phosphate (TmP)to GFR (TmP/GFR) were estimated.Results: At baseline, eGFR showed moderate chronic kidney disease (mean: 35.50 ±2.02, 33.14 ± 1.63, and 39.97±1.84 ml/min/1.73m2 in the 3 groups respectively); 54(52.9%) patients had hyperphosphataemia (>1.4mmo/L); 43 (42.2%) had normophosphataemia(0.6-1.4mmol/L); 5 (4.9%) had hypophosphataemia ( 1.35mmol/l).Conclusion: HIV causes kidney dysfunction with reduced phosphate excretion resultingin hyperphosphataemia but HAART improves renal function. Prolonged use of TDFcan cause renal toxicity with hypophosphataemia as fractional excretion progressivelyincreased with duration of therapy unlike ZDV/3TC/NVP. The use of different thirdagents (either NVP or EFV) in zidovudine-based therapy results in significantly differentplasma phosphate levels; ZDV/3TC/EFV, like TDF/FTC/EFV, resulted in significantlygreater decline in plasma phosphate than ZDV/3TC/NVP. Thus, Evafirenz (EVF)may have similar or synergistic adverse effects with tenofovir disoproxil fumarate(TDF).
机译：背景：高效抗逆转录病毒疗法 （HAART） 与低磷血症的肾功能不全有关。目的：前瞻性评价HAART使用期间肾脏磷酸盐排泄情况。方法：新诊断的人类免疫缺陷病毒（HIV）感染者采用富马酸替诺福韦二吡呋酯/恩曲他滨/依非韦伦（TDF/FTC/EFV），n=33;齐多夫定/拉米夫定/奈韦拉平 （ZDV/3TC/NVP），n=53;和齐多夫定/拉米夫定/依非韦伦 （ZDV/3TC/EFV），n=16。在基线、1、3、6 和 9 个月时同时测定血液和尿液中的肌酐和磷酸盐。估计肾小球滤过率（eGFR）、磷酸盐排泄和重吸收分数（FEPi %和TRP）以及肾小管最大磷酸盐重吸收率（TmP）与GFR（TmP/GFR）的比值。结果：基线时，eGFR显示中度慢性肾脏病（3组分别为35.50±2.02、33.14±1.63和39.97±1.84 ml/min/1.73m2）;高磷血症54例（52.9%）（>1.4mmo/L）;43例（42.2%）磷血症正常（0.6-1.4mmol/L）;5例（4.9%）为低磷血症（1.35mmol/L）。结论：HIV引起肾功能不全，磷酸盐排泄减少，导致高磷血症，但HAART可改善肾功能。与ZDV/3TC/NVP不同，长期使用TDF可引起肾毒性伴低磷血症，因为排泄分数随着治疗时间的延长而逐渐增加。在基于齐多夫定的治疗中使用不同的第三种药物（NVP 或 EFV）会导致血浆磷酸盐水平显着差异;与 TDF/FTC/EFV 一样，ZDV/3TC/EFV 导致血浆磷酸盐的下降幅度明显大于 ZDV/3TC/NVP。因此，Evafirenz （EVF） 可能与富马酸替诺福韦二吡呋酯 （TDF） 具有相似或协同的不良反应。

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