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| DOI： |
| 中文关键词: 洛匹那韦/利托那韦 HIV AIDS 抗反转录病毒治疗 血肌酐 肾小球滤过率 替诺福韦 |
| 英文关键词: lopinavir/ritonavir HIV AIDS antiretroviral therapy serum creatinine estimated glomerular filtration rate tenofovir |
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| 中文摘要: |
| 探讨以洛匹那韦/利托那韦（lopinavir/ritonavir, LPV/r）为核心，联合2个核苷类反转录酶抑制剂治疗的HIV感染初治患者肾功能的变化。方法 以2017年广州医科大学附属市八医院感染门诊221例接受LPV/r联合拉米夫定（lamivudine, 3TC）及替诺福韦（tenofovir, TDF）或齐多夫定（zidovudine, AZT）或司他夫定（stavudine, D4T）方案治疗，随访时间超过36个月的HIV感染初治患者为研究对象，根据方案是否包括TDF，将患者分为TDF组和非TDF组，比较2组抗反转录病毒治疗（antiretroviral therapy, ART）36个月期间病毒学和免疫学应答，及反映肾功能的血肌酐（serum creatinine, Scr）和肾小球滤过率（estimated glomerular filtration rate, eGFR）的变化。主要观察终点：治疗36个月时Scr和eGFR。结果 221例患者中TDF组30例，非TDF组191例。 2组年龄、性别、HIV感染途径、WHO分期、合并机会性感染，基线CD4+ T细胞计数、Scr及eGFR水平差异均无统计意义（P均＞0.05）。2组接受ART后12、24、36个月的HIV-1抑制率均达到100%，CD4+ T细胞计数均较基线显著上升（P均＜0.05）。2组ART后Scr水平从6个月开始较基线明显上升（P＜0.05），且TDF组从治疗12个月开始各随访时间点Scr水平就明显高于非TDF组（P均＜0.05）。2组ART后各随访时间点eGFR均较基线下降（P＜0.05），于ART后6个月即达到平台期，TDF组从ART后6个月开始各随访时间点eGFR即明显低于非TDF组（P均＜0.05）。结论 LPV/r联合3TC及TDF/AZT/D4T方案治疗HIV感染初治患者具有良好疗效，但影响其肾功能，尤其联合TDF时更明显，应对使用该方案患者加强肾功能监测。 |
| 英文摘要: |
| To observe the changes of renal function in treatment-na?ve HIV-infected patients treated with lopinavir/ritonavir (LPV/r) as the core component, combined with 2 nucleoside reverse transcriptase inhibitors. Methods A total of 221 treatment-na?ve HIV-infected patients treated with LPV/r combined with lamivudine (3TC) and tenofovir (TDF) or zidovudine (AZT) or stavudine (D4T) in Infection Outpatient of Guangzhou Eighth People’s Hospital, Guangzhou Medical University in 2017 were included in the study, and they were followed up for 36 months. Patients were divided into TDF group and non-TDF group according to the presence or absence of TDF in treatment regimen. The changes of virologic and immunological responses and indexes of renal function, including serum creatinine (Scr) and estimated glomerular filtration rate (eGFR) during 36 months of antiretroviral therapy (ART) were compared between 2 groups. The primary endpoint was Scr and eGFR levels at 36 months of treatment. Results Among 221 patients, there were 30 cases in the TDF group and 191 cases in the non-TDF group. There were no significant differences between 2 groups in age, gender, HIV infection route, WHO staging, opportunistic infections, baseline CD4+ T cell counts, Scr and eGFR levels (P＞0.05). The HIV-1 suppression rates in both groups were up to 100% at 12, 24 and 36 months after ART, and the CD4+ T cell counts were significantly higher than those on baseline (P＜0.05). Scr levels in both groups were significantly higher than these on baseline since the time point of 6 months after ART (P＜0.05), and Scr levels in TDF group were significantly higher than those in non-TDF group at each follow-up time point since 12 months after ART (P＜0.05). Compared with the baseline, the eGFR of 2 groups decreased at each follow-up time point after ART (P＜0.05), and reached a plateau at 6 months after ART. At each follow-up time point since 6 months after ART, eGFR in TDF group was significantly lower than that in non-TDF group (P＜0.05). Conclusions The treatment regimen of LPV/r combined with 3TC and TDF/AZT/D4T has good efficacy in treatment-na?ve HIV-infected patients, but affects the renal function of patients, especially when combined with TDF, indicating that renal function monitoring should be strengthened in patients using such regimens. |
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