替诺福韦减量服用对艾滋病合并慢性肾脏病患者的临床 效果分析

doi:10.19871/j.cnki.xfcrbzz.2023.03.005

摘要/Abstract

摘要： 目的分析替诺福韦（TDF）减量为隔日服用对艾滋病合并慢性肾脏病（CKD）患者的病毒载量和肾脏功能影响,评估其临床效果。方法回顾性分析南宁市第四人民医院感染科2016年1月至2018年12月使用拉米夫定（3TC）+TDF+依非韦伦/奈韦拉平（EFV/NVP）进行治疗的艾滋病患者,将其中因合并慢性肾脏病使用TDF 300mg隔日1次的艾滋病患者纳入试验组（100例）,未调整TDF剂量的艾滋病患者纳入对照组（100例）,采用CKD-EPI Scr公式计算估计的肾小球滤过率（eGFR）,分析治疗96周后患者病毒学结局和肾功能变化。结果治疗96周后,试验组和对照组的病毒学抑制率分别为84%和82%,无明显差异。试验组96周eGFR为90.4（73.0,101.0）ml/min,较基线83.3（72.1,93.6）ml/min有明显改善（P<0.001）;对照组96周eGFR为110.7（94.3,118.1）ml/min,与基线110.6（88.6,115.9）ml/min无明显差异（P=0.154）。两组96周血磷均较基线降低。结论 TDF 300mg隔日1次能够改善艾滋病合并CKD患者的肾功能,并维持良好的抗病毒治疗效果,有望成为一种新的优化治疗方案。

关键词: 艾滋病, 慢性肾脏病, 替诺福韦, 减量, 疗效

Abstract: Objective To analyze the effect of tenofovir (TDF) 300mg every other day on viral load and renal function in patients with HIV combined with chronic kidney disease, and to evaluate its clinical efficacy. Method patients with AIDS who treated with lamivudine (3TC) +TDF+ efevirenz/nevirapine (EFV/NVP) in the Department of Infectious Diseases of the Fourth People's Hospital of Nanning from January 2016 to December 2018 were retrospectively analyzed. Patients with AIDS combined with chronic kidney disease treated with TDF 300mg once every other day were included in the experimental group. Patients with AIDS without TDF dose adjustment were included in the control group. CKD-EPI Scr formula was used to calculate the estimated glomerular filtration rate (eGFR), and the virological outcome and renal function changes of patients after 96 weeks of treatment were analyzed. Result After 96 weeks of treatment, the virological suppression rates of the experimental group and the control group were 84% and 82%, respectively, with no significant difference between the two groups. The eGFR of the experimental group at 96 weeks was 90.4 (73.0, 101.0) ml/min, which was significantly improved from 83.3 (72.1, 93.6) ml/min at baseline (P<0.001). In the control group, the eGFR at 96 weeks was 110.7 (94.3, 118.1) ml/min, which was not significantly different from the baseline 110.6 (88.6, 115.9) ml/min (P=0.154). At 96 weeks, serum phosphorus decreased compared with baseline in both groups. Conclusion TDF 300mg once every other day can improve the renal function of patients with AIDS combined with CKD and maintain a good effect of antiviral therapy. It may be a new optimized treatment regimen.

Key words: Acute respiratory syndrome, Chronic kidney disease, Tenofovir, Dose reduction, Efficacy

中图分类号:

欧汝志, 李雪琴, 秦英梅, 董文逸, 黄欣欣. 替诺福韦减量服用对艾滋病合并慢性肾脏病患者的临床效果分析[J]. 新发传染病电子杂志, 2023, 8(3): 25-28.

Ou Ruzhi, Li Xueqin, Qin Yingmei, Dong Wenyi, Huang Xinxin. Clinical effect of tenofovir taken every other day in patients with HIV combined with chronic kidney disease[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(3): 25-28.

参考文献

[1] 中国疾病预防控制中心性病艾滋病预防控制中心. 国家免费艾滋病抗病毒药物治疗手册[M]. 4版. 北京: 人民卫生出版社, 2019: 28-29.
[2] SAAG MS, GANDHI RT, HOY JF, et al.Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the international antiviral society-USA panel[J]. JAMA, 2020, 324(16): 1651-1669.
[3] DHHS. Guidelines for the Use of Antiretroviral Agents inAdults and Adolescents with HIV[M/OL].[2023-03-13]. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new-guidelines.
[4] EACS. European aids clinical society guidelines[M/OL].[2023-03-13]. https://www.eacsociety.org/guidelines/eacs-guidelines/.
[5] 中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 中华内科杂志, 2021, 60(12): 1106-1128.
[6] MURPHY MD, O'HEARN M, CHOU S. Fatal lactic acidosis and acute renal failure after addition of tenofovir to an antiretroviral regimen containing didanosine[J]. Clin Infect Dis, 2003, 36(8): 1082-1085.
[7] KARRAS A, LAFAURIE M, FURCO A, et al.Tenofovir related nephrotoxicity in human immunodeficiency virus infected patients: three cases of renal failure, Fanconi syndrome, and nephrogenic diabetes insipidus[J]. Clin Infect Dis, 2003, 36(8): 1070-1073.
[8] COCA S, PERAZELLA M A.Rapid communication: acute renal failure associated with tenofovir: evidence of drug induced nephrotoxicity[J]. Am J Med Sci, 2002, 324(6): 342-344.
[9] V ERHELST D, MONGE M, MEYNARD JL, et al. Fanconi syndrome and renal failure induced by tenofovir: a first case report[J]. Am J Kidney Dis, 2002, 40(6): 1331-1333.
[10] UNAIDS. UNAIDS Global AIDS Update2022[M/OL].[2023-03-13]. https://www.unaids.org/sites/default/files/media_asset/2022-global-aids-update_en.pdf
[11] CAO Y, GONG M, HAN Y, et al.Prevalence and risk factors for chronic kidney disease among HIV-infected antiretroviral therapy-naïve patients in mainland China: a multicenter cross-sectional study[J]. Nephrology (Carlton), 2013, 18(4): 307-312.
[12] CHEUNG CY, WONG KM, LEE MP, et al.Prevalence of chronic kidney disease in Chinese HIV-infected patients[J]. Nephrol Dial Transplant, 2007, 22(11): 3186-3190.
[13] 乐晓琴,张仁芳.富马酸替诺福韦二吡呋酯对艾滋病患者肾脏毒性的研究进展[J/CD]. 新发传染病电子杂志, 2018,3(3): 150-152.
[14] LIU F, XU A, ZHAO H, et al.Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China[J]. Ther Clin Risk Manag, 2020, 16: 299-310.
[15] YANG J, CHEN J, JI Y, et al.Lipid profile and renal safety of tenofovir disoproxil fumarate-based anti-retroviral therapy in HIV-infected Chinese patients[J]. Int J Infect Dis, 2019, 83: 64-71.
[16] 江宇泳, 蔡晧东. 替诺福韦的肾脏-骨骼毒性及其防治[J]. 药物不良反应杂志, 2014,(3): 163-167.
[17] CRESSEY TR, AVIHINGSANON A, HALUE G, et al.Plasma and Intracellular Pharmacokinetics of Tenofovir Disoproxil Fumarate 300 mg Every 48 Hours vs 150 mg Once Daily in HIV-Infected Adults With Moderate Renal Function Impairment[J]. Clin Infect Dis, 2015, 61(4): 633-639.
[18] 王炬峰, 许利军, 黄莺, 等. 高效抗反转录病毒治疗对人类免疫缺陷病毒感染者骨代谢的影响[J]. 浙江大学学报(医学版), 2016, 45(3): 228-235.
[19] BREGIGEON S, SOLAS C, FAUCHER O, et al.Impact of tenofovir dose adjustment on both estimated glomerular filtration rate and tenofovir trough concentration[J]. Antivir Ther, 2017, 22(6): 529-533.
[20] CHOTIYAPUTTA W, POOSANASUWANSRI K, KIATTISUNTHORN K, et al.Comparison of viral control between two tenofovir dose reduction regimens (300 mg every 48 hours versus 300 mg every 72 hours) in chronic hepatitis B patients with moderate renal impairment from tenofovir-induced renal dysfunction[J]. J Viral Hepat, 2021, 28(2): 364-372.