Antiretroviral Drugs and The Kidney: Dosage Adjustment and Renal Tolerance

Hassane      Izzedine; Vincent      Launay-Vacher; Gilbert      Deray

Abstract

Background. Acquired immunodeficiency syndrome (AIDS)-related kidney disorders concern 30% of those patients and can lead to end-stage renal disease (ESRD; 0.6 to 1%). Therefore, administration of antiretroviral drugs in human immunodeficiency virus (HIV) patients with nephropathy is not uncommon. Aim of the review. Since renal insufficiency is not uncommon among HIV-infected patients treated with antiretroviral drugs, guidelines on how to use these drugs in the pattern of an altered renal function are mandatory. This review provides such guidelines established on the basis of pharmacokinetic and clinical studies reported in the international literature. In addition, some of these drugs may be nephrotoxic. Mechanisms and clinical and / or biological manifestations are reviewed to help monitor renal tolerance in patients receiving these drugs. Conclusion. Antiretroviral drugs dosage in HIV-infected patients with altered renal function should be cautiously determined. Drug dosage should not be systematically reduced since dosage adjustment is not mandatory for all therapies (ie. protease inhibitors). Furthermore, when dose reduction is necessary, pharmacokinetic and clinical data from the literature allows to establish practical guidelines on how to use these drugs in such patients.

Keywords: dosage adujstment, aids, hiv, nucleoside reverse transcriptase inhibitors, non nucleoside reverse transcriptase inhibitors, protease inhibitors, nucleotide reverse transcriptase inhibitors, fusion inhibitors, end-stage renal disease