An appraisal of antiretroviral drugs in hemodialysis.
BACKGROUND
Acquired immunodeficiency syndrome (AIDS)-related kidney disorders concern 30% of those patients and can lead to end-stage renal disease (ESRD; 6 to 10%). Therefore, the administration of antiretroviral drugs in human immunodeficiency virus (HIV) patients with nephropathy is not uncommon.


METHODS
The influence of ESRD on the different phases of the pharmacokinetic profile of drugs in general is examined in light of bioavailability, distribution, protein binding, metabolism, and elimination. Then, the pharmacokinetics of antiretroviral drugs in hemodialysis are detailed.


RESULTS
From these data, dosing recommendations are given for nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs, and protease inhibitors (PIs).


CONCLUSIONS
Dosage adjustments are often necessary for patients with renal insufficiency. These adaptations have to be carefully performed to optimize drug exposure and reduce the risk of side effects.
Izzedine
H
H
Department of Nephrology, Pitie Salpetriere Hospital, Paris, France. hassan.izzedine@psl.ap-hop-paris.fr
Launay-Vacher
V
V
Baumelou
A
A
Deray
G
G
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D019540:Area Under Curve; D004334:Drug Administration Schedule; D017408:Guidelines as Topic; D006801:Humans; D015394:Molecular Structure; D011480:Protease Inhibitors / Q000493:pharmacokinetics; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D018894:Reverse Transcriptase Inhibitors / Q000493:pharmacokinetics
D019380:Anti-HIV Agents; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors