Antiretroviral drugs and the kidney: dosage adjustment and renal tolerance.
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.


OBJECTIVE
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.


CONCLUSIONS
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.
Izzedine
Hassane
H
Department of Nephrology, Pitié Salpétriere Hospital, Paris, France. hassan.izzedine@psl.ap-hop-paris.fr
Launay-Vacher
Vincent
V
Deray
Gilbert
G
D016263:AIDS-Associated Nephropathy / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D000818:Animals; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D003404:Creatinine / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D008657:Metabolic Clearance Rate; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology* / Q000378:metabolism / Q000628:therapy
D019380:Anti-HIV Agents; D003404:Creatinine