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Том 23 №1 - Приложение 2021 год - Нефрология и диализ

Антиретровирусная терапия и почки: Баланс пользы и риска у пациентов с ВИЧ-инфекцией. Обзор литературы


Ющук Н.Д. Волгина Г.В. Гаджикулиева М.М.

DOI: 10.28996/2618-9801-2021-1suppl-74-98

Аннотация: Достижения в фармакологическом лечении ВИЧ-инфекции продолжаются быстрыми темпами. В настоящее время доступны более чем 30 антиретровирусных препаратов (АРВП) и их сочетаний, применение которых может подавить вирусную нагрузку ВИЧ до незаметного уровня и увеличить продолжительность жизни ВИЧ-инфицированных людей. Там, где пациенты имеют доступ к лечению, заболеваемость и смертность все чаще обусловливаются сопутствующими заболеваниями, не связанными с ВИЧ, которые могут наблюдаться раньше, чем при соответствующем возрасту контроле. Хотя большинство АРВП относительно не нефротоксичны, может иметь место повреждение почек, связанное с лекарствами, и его необходимо отличать от прогрессирования заболеваний почек, связанных с ВИЧ, другими инфекциями (например, гепатитом С) или заболеваниями почек, не связанными с ВИЧ-инфекцией и ее лечением. Наиболее распространенные нефротоксические эффекты АРВП включают острое повреждение почек, тубулоинтерстициальный нефрит, кристалл-индуцированную обструкцию и почечнокаменную болезнь, вторичную по отношению к применению ингибиторов протеаз (главным образом индинавира и атазанавира), повреждение проксимальных канальцев, связанное с нуклеозидным ингибитором обратной транскриптазы ВИЧ - тенофовиром. Наконец, неспецифические метаболические осложнения могут увеличить риск развития сосудистой хронической болезни почек (ХБП) у пациентов, получающих антиретровирусную терапию (АРТ). Нарушение функции почек обычно развивается в условиях многократного лечения и не всегда может быть отнесено к конкретному препарату, поэтому у пациентов с ВИЧ, получающих любые АРВП, следует регулярно контролировать функцию почек. Учитывая преимущества АРT, страх перед нефротоксическими эффектами никогда не является веской причиной для отказа от ее применения. Идентификация пациентов с уже существующей ХБП, которые подвергаются повышенному риску повреждения почек, позволяет проводить соответствующую модификацию дозы, тщательный мониторинг и избегать или осторожно использовать потенциально нефротоксичные препараты. Учитывая распространенность ХБП, широкий спектр возможных взаимодействий между ВИЧ, АРВП, ХБП и ее лечением, нефрологам необходимо знать о возможном влиянии комбинированной АРТ на почки. В обзоре рассматриваются вопросы, касающиеся механизмов, факторов риска и клинических проявлений повреждения почек медикаментозными средствами для оценки клинической ситуации при проведении терапии антиретровирусными препаратами и обсуждаются меры профилактики их нефротоксического действия.

Для цитирования: Ющук Н.Д., Волгина Г.В., Гаджикулиева М.М. Антиретровирусная терапия и почки: Баланс пользы и риска у пациентов с ВИЧ-инфекцией. Обзор литературы. Нефрология и диализ. 2021. 23(1):74-98. doi: 10.28996/2618-9801-2021-1suppl-74-98

Весь текст



Ключевые слова: ВИЧ-инфекция, повреждение почек, антиретровирусные препараты, антиретровирусная терапия, нефротоксичность, факторы риска, профилактика, HIV-infection, renal damage, review, antiretroviral drugs, antiretroviral therapy, nephrotoxicity, risk factors, preventive measures

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