联合抗病毒治疗药物对HIV/AIDS病人肾脏的影响  

Influence of highly active antiretroviral therapy on kidney of HIV/AIDS patients

作　　者：张立成[1] 马剡芳[1] 万钢[1] 杨松[1] 张铭[1] 李蔚丽[1] 杨涤[1] 

机构地区：[1]首都医科大学附属北京地坛医院急诊科,北京100015

出　　处：《中国艾滋病性病》2016年第6期416-420,共5页Chinese Journal of Aids & STD

基　　金：北京市朝阳区艾滋病和病毒性肝炎等重大传染病综合防治示范区建设研究;国家十二五重大专项(2012ZX10004-904)~~

摘　　要：目的通过对艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)不同抗病毒治疗方案治疗效果的临床观察,了解各方案对肾小球滤过率的影响。通过分析估计肾小球滤过率(eGFR)的变化作为肾脏功能评定的指标,找出影响因素。方法采用回顾性分析方法,收集首都医科大学附属北京地坛医院2010-2014年以来确诊HIV/AIDS病人并给予抗病毒治疗的门诊及住院患者的临床资料,使用eGFR作为肾脏功能评定的指标,比较各组抗病毒治疗方案治疗前后及组间eGFR的变化特点。结果初治患者给予一线抗病毒治疗方案:齐多夫定(AZT)+拉米夫定(3TC)+奈韦拉平(NVP)和替诺福韦(TDF)+3TC+依非韦仑(EFV)。之前接受过一线抗病毒治疗,病毒学检测确定为治疗失败者更换二线治疗方案:TDF+3TC+洛匹那韦/利托那韦(LPV/r)。随着用药时间的延长,AZT+3TC+NVP组eGFR值总体呈上升趋势(随访6个月及12个月eGFR值分别上升3.28ml/min/1.73m2和1.22ml/min/1.73m2),TDF+3TC+EFV组和TDF+3TC+LPV/r组eGFR值是逐渐下降的,TDF+3TC+LPV/r组下降程度大于TDF+3TC+EFV组(P<0.013)。在抗病毒治疗过程中,除药物因素外,引起肾功能损伤的相关危险因素中,年龄因素是最主要的。结论抗病毒治疗方案AZT+3TC+NVP对肾脏功能具有一定的改善作用,对于初治伴肾损伤的患者可考虑用该方案治疗。TDF+3TC+EFV和TDF+3TC+LPV/r方案对肾功能下降的影响是随着用药时间延长逐渐加重的,其中TDF+3TC+LPV/r方案影响最显著。选择抗病毒治疗方案时除肾功能因素外,患者的年龄因素也是需要重点关注的。Objective To compare the influence of different regimens of highly active antiretroviral therapy（HAART）on GFR of AIDS patients,and to analyze the changes of eGFR as an indicator of renal function and find the relevant influencing factors so as to know more reasonable option of HAART regimens.Methods Retrospective analysis was conducted based on the clinical data of AIDS patients diagnosed and treated by HAART in Beijing Ditan hospital from 2011 to 2014.There were three groups of AIDS patients under HAART：two treated with the firstline regimens of AZT＋3TC＋NVP and TDF＋3TC＋EFV,and one who failed in the first-line regimen treated with the second-line regimen of TDF＋3TC＋LPV/r.eGFR was used as an indicator to evaluate the renal function and the changes of eGFR of the three groups with different regimens before and after HAART.Results The HAART time was longer,the group of AZT＋3TC＋NVP was getting higher eGFR and the values increased by 3.28 ml/min/1.73m2 and 1.22ml/min/1.73m2 respectively,after 6-m and 12-m HAART.The other two groups of TDF＋3TC＋EFV and TDF＋3TC＋LPV/r had the eGFR decreased.HAART drugs were one of the factors to damage the renal function,followed by the factor of age.Conclusion The regimen of AZT＋3TC＋NVP may improve the renal function,esp.for the initial treat cases.The regimens of TDF＋3TC＋EFV and TDF＋3TC＋LPV/r may cause kidney damage as HAART time is getting longer esp.the regimen of TDF＋3TC＋LPV/r.We must pay attention to the age of patients when initiating HAART.

关 键 词：艾滋病病毒感染者/艾滋病病人 CD4+T淋巴细胞 估计肾小球滤过率 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]