丙酚替诺福韦治疗HIV感染患者的肾脏安全性研究进展

doi:10.19871/j.cnki.xfcrbzz.2025.06.015

摘要/Abstract

摘要： 大部分抗反转录病毒治疗药物中的核苷类反转录酶抑制剂主要经过肾脏清除,药物的蓄积可能会对HIV感染者的肾功能产生不利影响;其中,富马酸替诺福韦二吡呋酯的肾毒性一直备受关注,其较高的血浆替诺福韦暴露量与肾脏和骨骼不良事件高风险相关。丙酚替诺福韦是一种替诺福韦前体药物,具有较高的病毒学抑制疗效,同时可降低约90%的血浆替诺福韦暴露量,相较于富马酸替诺福韦二吡呋酯对肾脏的影响更小。大量临床试验和真实世界研究显示,包含丙酚替诺福韦的抗反转录病毒治疗方案用于HIV感染者治疗的肾脏安全性良好。本文综述现有包含丙酚替诺福韦的抗反转录病毒治疗方案用于不同肾功能状况的HIV感染者的肾脏安全性证据及相关文献资料,旨在为临床HIV感染者应用TAF治疗提供指导和参考。

关键词: 人类免疫缺陷病毒感染, 丙酚替诺福韦, 抗反转录病毒治疗, 肾脏安全性

Abstract: Most reverse transcriptase inhibitors among antiretroviral therapy drugs are predominantly eliminated via the renal pathway. Drug accumulation may exert an adverse impact on renal function in HIV-infected patients. Among these agents, the nephrotoxicity of tenofovir disoproxil fumarate has long been a major concern, as its relatively high plasma tenofovir exposure is associated with an increased risk of renal and skeletal adverse events. Tenofovir alafenamide is a prodrug of tenofovir, which exhibits high virologic suppression efficacy while reducing plasma tenofovir exposure by approximately 90%. Consequently, tenofovir alafenamide has a significantly lower potential for renal toxicity compared with tenofovir disoproxil fumarate. Numerous clinical trials and real-world studies have demonstrated that antiretroviral therapy regimens containing tenofovir alafenamide confer favorable renal safety profiles in HIV-infected patients. This review summarizes the current evidence and relevant literature regarding the renal safety of tenofovir alafenamide-containing antiretroviral therapy regimens in HIV-infected patients with different renal function statuses, aiming to provide clinical guidance and references for the rational use of tenofovir alafenamide in the treatment of HIV-infected patients.

Key words: Human immunodeficiency virus infected, Tenofovir alafenamide, Antiretroviral therapy, Renal safety

中图分类号:

R563.1

王思苑, 张路坤, 何云. 丙酚替诺福韦治疗HIV感染患者的肾脏安全性研究进展[J]. 新发传染病电子杂志, 2025, 10(6): 93-100.

Wang Siyuan, Zhang Lukun, He Yun. Research progress on the renal safety of tenofovir alafenamide in HIV-infected individuals[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(6): 93-100.

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