ĐÁNH GIÁ THAY ĐỔI CHỈ SỐ MEN GAN VÀ MỨC LỌC CẦU THẬN Ở NGƯỜI BỆNH HIV/AIDS SAU ĐIỀU TRỊ ARV TẠI TRUNG TÂM BỆNH NHIỆT ĐỚI, BỆNH VIỆN BẠCH MAI

Abstract

Introduction: Long-term antiretroviral therapy has been associated with impaired liver and kidney function in patients. This study was conducted with the objective to evaluate liver enzyme and glomerular filtration rate progression in HIV-infected patients after starting ARV at Bach Mai Hospital. Participants and Methods: Retrospective observation study among 648 patients registered and under treatment at the outpatient clinic, Center for Tropical Diseases, Bach Mai Hospital. The ALT, AST, and serum creatinine were assessed at the time before ARV and every 6 months after that. The total evaluation period was 3 years from the time of initiation of treatment. Results: At baseline, the rate of patients with reduced glomerular filtration rate <90 mL/min/1.73m² was 18.2%. After 6 months, this rate increased to 24.5%; after 12 months was 28.4%; 24 months was 29.0% and after 36 months was 30.6%. Liver enzymes ALT and AST did not change significantly after ARV initiation. Multivariate GEE model showed that the risk of renal function impairment increased with age. Patients treated with regimens containing TDF had a rate of decline eGFR 2.69 times higher than those using regimens AZT or d4T (aOR=2.69; 95% CI=1.79-403). Daily smoking is also a risk factor for increased renal function impairment. For impaired liver function, harmful alcohol abuse was one of the leading risk factors with aOR=1.46 (95% CI=1.08 – 1.97). Patients on regimens with EFV also had a higher rate of elevation of liver enzymes with aOR=1.72 (95% CI=1.00 – 2.99). Conclusion: The study reported a high rate of decreased glomerular filtration rate and an average rate of elevated liver enzymes in HIV patients after 3 years of ARV treatment at Bach Mai Hospital.