High prevalence of indinavir-associated renal complications in Thai HIV-infected patients.
BACKGROUND
Indinavir (IDV) is the protease inhibitor (PI) used most often in resource-limited countries. The present study aimed to determine the prevalence of IDV-associated renal complications as well as their clinical characteristics.


METHODS
The authors reviewed all patients participating in cohorts of indinavir-containing regimens at the HIV-NAT research center during the period of indinavir treatment. Patients who had pre-existing renal diseases were excluded. Renal toxicities included presence of urologic symptoms, nephrolithiasis, abnormal urine sediments, crystalluria and loss of renal function. Radiological studies of KUB system were reviewed as well.


RESULTS
Two-hundred and four patients treated with IDV were included. Median (IQR) follow up period was 216 (150-312) weeks. One hundred and eighty patients were treated with ritonavir-boosted regimens at some point, and 24 patients were treated only with unboosted regimens. Leukocyturia (51.9%) was the most common finding of IDV-associated renal complications. Thirty-five percent of patients had urologic symptoms such as flank pain or dysuria. Almost half of the patients had significant loss of renal function that was associated with prolonged use of IDV The most common radiological finding was nephrolithiasis. Less common, but of greater clinical importance, are nephrocalcinosis or renal atrophy.


CONCLUSIONS
A high prevalence of IRC was found in Thai HIV-infected patients. As long as no other cost-effective boosted PI regimens are available, strategies to prevent irreversible loss of renal function are warranted.
Avihingsanon
Anchalee
A
HIV-NAT study team, Thai Red Cross AIDS Research Centre.
Avihingsanon
Yingyos
Y
Darnpornprasert
Praniti
P
Kerr
Stephen
S
Ungsedhapand
Chaiwat
C
Duncombe
Chris
C
Ubolyam
Sasiwimol
S
Ruxrungtham
Kiat
K
Phanuphak
Praphan
P
D000328:Adult; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006679:HIV Seropositivity / Q000188:drug therapy*; D006801:Humans; D019469:Indinavir / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects*; D007669:Kidney Calculi / Q000139:chemically induced* / Q000000981:diagnostic imaging; D007964:Leukocytosis / Q000139:chemically induced*; D008297:Male; D010146:Pain / Q000139:chemically induced*; D015995:Prevalence; D011859:Radiography; D051437:Renal Insufficiency / Q000139:chemically induced*; D013785:Thailand; D014463:Ultrasonography; D014570:Urologic Diseases / Q000139:chemically induced*
D017320:HIV Protease Inhibitors; D019469:Indinavir