title: Ritonavir-boosted atazanavir exposure is associated with an increased rate of renal stones compared with efavirenz, ritonavir-boosted lopinavir and ritonavir-boosted darunavir.
abstract: There have been no data presented on the relative rates of the development of renal stones in those receiving ritonavir-boosted atazanavir (ATZ/r) when compared with other commonly used antiretrovirals (ARVs). We compared the rate of development of renal stones in a cohort of HIV-infected individuals attending the Chelsea and Westminster Hospital Foundation Trust exposed to ATZ/r with those exposed to efavirenz (EFV)/ritonavir-boosted lopinavir (LPV/r) and ritonavir-boosted darunavir (DRV/r) over a 45-month study period. The rate of development of renal stones in the ATZ/r group (n = 1206) compared with the EFV/LPV/r/DRV/r combined group (n = 4449) was 7.3 [95% confidence interval (CI) 4.7-10.8] per 1000 patient-years and 1.9 (95% CI 1.2-2.8) per 1000 patient-years (P < 0.001), respectively. The renal stones rate remained significantly higher in the ATZ/r group after adjusting for prior ATZ/r/indinavir (IND) exposure. When choosing a boosted protease inhibitor, ATZ/r renal stones should be considered as a potential comorbidity.
authors.affiliation: Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK. neesha.rockwood@doctors.org.uk
authors.forename: Neesha
authors.initials: N
authors.lastname: Rockwood
authors.forename: Sundhiya
authors.initials: S
authors.lastname: Mandalia
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000009:adverse effects; D001663:Bilirubin / Q000652:urine; D015331:Cohort Studies; D003521:Cyclopropanes; D000069454:Darunavir; D004359:Drug Therapy, Combination / Q000009:adverse effects; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D061466:Lopinavir; D053040:Nephrolithiasis / Q000139:chemically induced*; D009842:Oligopeptides / Q000009:adverse effects*; D011725:Pyridines / Q000009:adverse effects*; D011744:Pyrimidinones / Q000009:adverse effects; D012189:Retrospective Studies; D019438:Ritonavir / Q000009:adverse effects*; D013449:Sulfonamides / Q000009:adverse effects
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D011744:Pyrimidinones; D013449:Sulfonamides; D061466:Lopinavir; D000069446:Atazanavir Sulfate; C098320:efavirenz; D019438:Ritonavir; D001663:Bilirubin; D000069454:Darunavir