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

Современная концепция хронической болезни почек при ВИЧ-инфекции


Волгина Г.В. Томилина Н.А. Гаджикулиева М.М.

DOI: 10.28996/2618-9801-2021-1suppl-11-31

Аннотация: Распространенность инфицирования вирусом иммунодефицита человека (ВИЧ) приняла характер пандемии. Антиретровирусная терапия (АРТ) заметно снизила смертность от синдрома приобретенного иммунодефицита и оппортунистических инфекционных заболеваний, что привело к увеличению продолжительности жизни людей, инфицированных ВИЧ, но при этом увеличилась частота хронической болезни почек (ХБП), осложняющей ВИЧ-инфекцию. ХБП является сопутствующей патологией, имеющей большое клиническое значение среди людей, живущих с ВИЧ (ЛЖВ), и связана со значительной заболеваемостью и смертностью. Этиология заболеваний почек среди ЛЖВ включает заболевания, связанные с ВИЧ, такие как классическая нефропатия, ассоциированная с ВИЧ, или иммунокомплексные заболевания, ХБП, связанную с неинфекционной сопутствующей патологией (НСП) и антиретровирусной токсичностью. Хотя уже давно признано, что ВИЧ-инфекция является фактором риска ХБП, важно отметить, что характер заболевания почек у ЛЖВ изменился. Вместо ранее наблюдавшихся ВИЧ-ассоциированных заболеваний почек или острого повреждения почек, связанных с такими заболеваниями как оппортунистические инфекции, в настоящее время ХБП часто связана с НСП. Факторы риска развития ХБП у ВИЧ-инфицированных лиц включают старение, артериальную гипертензию, сахарный диабет, ко-инфекцию вирусом гепатита С, низкое количество клеток CD4, высокую вирусную нагрузку и ряд других. Все большее значение в мониторинге ЛЖВ приобретает кумулятивный токсический эффект АРТ, действие которой может привести к повреждению нескольких органов, в том числе и почек, следствием чего может быть значительное снижение качества жизни инфицированных лиц. ХБП также связана с увеличением госпитализации, особенно у пожилых пациентов и пациентов с коморбидной сердечно-сосудистой патологией. ХБП, однажды установленная, часто неуклонно прогрессирует и может привести к терминальной стадии почечной недостаточности, вероятность развития которой в 2-20 раз выше, чем у населения в целом. Выявление пациентов с факторами риска ХБП и соответствующий скрининг для раннего выявления ХБП имеют жизненно важное значение для улучшения результатов лечения пациентов. ВИЧ-инфекция и ХБП являются двумя эпидемическими заболеваниями с важными социальными, клиническими и экономическими последствиями. Взаимодействие между этими двумя болезнями представляет собой пересечение между инфекционными и неинфекционными заболеваниями. Этот обзор литературы предназначен для оценки современной проблемы, связанной с ХБП у лиц, живущих с вирусной инфекцией.

Для цитирования: Волгина Г.В., Томилина Н.А., Гаджикулиева М.М. Современная концепция хронической болезни почек при ВИЧ-инфекции. Нефрология и диализ. 2021. 23(1):9-126. doi: 10.28996/2618-9801-2021-1suppl-11-31


Весь текст

Ключевые слова: вирус иммунодефицита человека, хроническая болезнь почек, эпидемиология, факторы риска, антиретровирусная терапия, human immunodeficiency virus, chronic kidney disease, epidemiology, risk factors, antiretroviral therapy

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