indinavir-sulfate and AIDS-Associated-Nephropathy

The widespread introduction of highly active antiretroviral therapy (HAART) in the mid-1990s dramatically altered the course of human immunodeficiency virus (HIV) infection, with improvements in survival and reductions in the incidence of AIDS-defining illnesses. Although antiretroviral therapy has been shown to reduce the incidence of both AIDS-defining and non-AIDS conditions, long-term exposure to HAART may also be associated with significant toxicity. This article reviews the potential nephrotoxicity of specific antiretroviral agents and the impact of antiretroviral therapy on related metabolic disorders. The antiretroviral agents most strongly associated with direct nephrotoxicity include the nucleotide reverse transcriptase inhibitor, tenofovir, and the protease inhibitor indinavir, although other agents have been implicated less frequently. Tenofovir and related nucleotide analogs have primarily been associated with proximal tubular dysfunction and acute kidney injury, whereas indinavir is known to cause nephrolithiasis, obstructive nephropathy, and interstitial nephritis. Kidney damage related to antiretroviral therapy is typically reversible with early recognition and timely discontinuation of the offending agent, and nephrologists should be familiar with the potential toxicity of these agents to avoid delays in diagnosis.

Topics: Adenine; AIDS-Associated Nephropathy; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Humans; Indinavir; Kidney; Organophosphonates; Tenofovir

Topics: Abdominal Abscess; Acquired Immunodeficiency Syndrome; Adult; Aged; AIDS-Associated Nephropathy; Erectile Dysfunction; Humans; Indinavir; Kidney; Kidney Calculi; Lymphoma; Male; Male Urogenital Diseases; Middle Aged; Prostatic Diseases; Prostatitis; Sarcoma, Kaposi; Testicular Diseases; Urination Disorders

The aim of the study was to investigate the prevalence and aetiology of chronic kidney disease (CKD) and trends in estimated glomerular filtration rate (eGFR) in HIV-infected patients.. Ascertainment and review of CKD cases among patients attending King's College and Brighton Hospitals, UK were carried out. CKD was defined as eGFR <60 mL/min for > or =3 months. Longitudinal eGFR slopes were produced to examine trends in renal function before, during and after exposure to indinavir (IDV) or tenofovir (TFV).. CKD prevalence was 2.4%. While HIV-associated nephropathy accounted for 62% of CKD in black patients, 95% of CKD in white/other patients was associated with diabetes mellitus, hypertension, atherosclerosis and/or drug toxicity. Exposure to IDV or TFV was associated with an accelerated decline in renal function (4.6-fold and 3.7-fold, respectively) in patients with CKD. In patients initiating IDV, age > or =50 years increased the odds of CKD [odds ratio (OR) 4.9], while in patients initiating TFV, age > or =50 years (OR 5.4) and eGFR 60-75 mL/min (OR 17.2) were associated with developing CKD.. This study highlights the importance of metabolic and vascular disease to the burden of CKD in an ageing HIV-infected cohort. In patients who developed CKD, treatment with IDV or TFV was associated with an accelerated decline in renal function.

Topics: Adenine; Adult; Age Factors; AIDS-Associated Nephropathy; Analysis of Variance; Anti-HIV Agents; Female; Glomerular Filtration Rate; HIV-1; Humans; Indinavir; Kidney Failure, Chronic; Kidney Function Tests; Male; Middle Aged; Organophosphonates; Prevalence; Tenofovir; United Kingdom