| Objective:To observe the effects of long-term use of antiretroviral therapy(ART)regimen containing Tenofovir Disoproxil Fumarate(TDF)[TDF+lamivudine(3TC)+efavirenz(EFV)]on renal function inHuman Immunodeficiency Virus(HIV)/Acquired Immune Deficiency Syndrome(AIDS)patients.To explore applicable indicators for early assessment of renal function impairment,and to provide clinicians in Sichuan AIDS designated medical institutions with early detection of renal function impairment intervention,replacement of appropriate ART regimes and improvement of patient prognosis provide relevant study evidence.Methods:HIV/AIDS patients who were treated in outpatient service of Chengdu Public Health Clinical Medical Center during October to December 2017,and those patients were using TDF+3TC+EFV for 24 months or more were collected.Baseline(before ART)renal function related laboratory indicators and the number of patients who discontinued and replaced the regime due to renal impairments and renal function indicators were collected atstudy observation starting point,3,6,9,and 12 months study points.Related indicators of renal impairment:changes in blood ?2 microglobulin(?2-MG),urine ?2-MG,urine microalbumin,and urine protein.The glomerular filtration rate(eGFR)was estimated based on renal function indicators and the individuals with mild renal impairment(eGFR:60?89 ml/min/1.73m2)and eGFR decreased by>25%from baseline were observed.SPSS 22.0 statistical software was used to analyze the data.P<0.05 was considered statistically significant.Results:1.A total of 100 HIV/AIDS patients were included,median age and interquartile range(IQR)was 32(27,36)years old;males accounted for 97.00%(97/100),and the long-term use of ART was 38(36,41)months.2.The incidence of mild renal impairment was 1.00%,9.00%,0.00%,0.00%,1.02%at study observation starting point,3,6,9,and 12months point,there was no statistical significance(P>0.05).The incidence of mild renal impairment during the observation period was 10.00%(10/100).4 patients whose eGFR decreased by>25%from baseline.Among them,3 patients recovered eGFR above 90 ml/min/1.73m2 and one patient changed the ART regimen during the observation period,respectively.3.Compared with the baseline eGFR[125.23(117.01,131.27)m/l min/1.73m2],the median of eGFR(IQR)fluctuated between 115.88(110.04,122.43)?119.13(111.84,123.14)ml/min/1.73m2 was lower during the observation period.There was no significant difference(P<0.05).4.The incidence of urine ?2-MG abnormalities(>0.30mg/L),Serum?2-MG abnormalities(>3.00 mg/L),urine microalbuminemia(>30mg/L)and urine protein positive fluctuations were 39.18%?60.20%,9.00%?13.27%,1.00%?4.08%,respectively.The differences were statistically significant(P<0.05).5.The incidence of persistent urine(32-MG(sustained abnormality group)was 25.00%(25/100),and the eGFR of these patients were observed from 110.97(105.75,116.59)to 116.28(109.74,120.12)ml/min/1.73m2.The eGFR[117.18(104.22,113.05)?120.05(114.53,124.22)ml/min/1.73m2]were lower in the patients without persistent urine ?2-MG There were nosignificant differences between the two groups in the study observation starting point and 3(P=0.056,0.210);the differences in 6,9,and 12 were statistically significant(P=0.036,0.022,0.002,respectively).There were no significant differences between the two groups of patients at baseline eGFR and observation period,age,body mass index(BMI),CD4 cell count,CD4/CD8 cell ratio,HIV viral load,and baseline eGFR(P>0.05).Conclusions:1.HIV/AIDS patients who have been treated with TDF+3TC+EFV regimen for more than 2 years were at risk of mild renal damage.Paying attention to the dynamic changes of eGFR can help clinicians find mild renal damage in patients and timely intervene.2.The median duration of long-term treatment with TDF+3TC+EFV wasmorethan2 years.The incidence of persistent abnormalities of urine?2-MG in patients was higher and it was related to the decrease of eGFR levels.It was suggested that the routine clinical examination of urine ?2-MG in patients has positive clinical significance for early detection of renal damage,and it was of reference value for clinicians to intervene in time and replace the appropriate ART regime.3.The median duration of long-term treatment with TDF+3TC+EFV wasmorethan2 years.The detection of urinary microalbumin and urinary protein was not sensible for the detection of early renal impairment.Therefore,it was recommended to simultaneously detect markers of renal tubular injury,such as ?2-MG Prospective study on large samples with a longer time is needed in the future. |
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