title: Clinical features and risk factors for atazanavir (ATV)-associated urolithiasis: a case-control study.
abstract: OBJECTIVE
  Clinical features and risk factors for atazanavir (ATV)-associated urolithiasis have not been fully investigated.
  
  
  METHODS
  We reviewed all cases of ATV-containing urolithiasis identified by infrared spectrophotometry among HIV-infected patients over a 5-year period to describe their clinical features and outcome. A case-control study was performed to identify risk factors associated with ATV-associated urolithiasis using univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  30 cases of ATV-associated urolithiasis were analyzed. Patients were mostly men (87%), median age: 45.5 years, median CD4 cell count: 443 cells/µL and 97% had plasma HIV RNA level <50 cp/mL. Median time between the initiation of ATV-containing regimen and the diagnosis of urolithiasis was 3.1 years. Patients presented with flank pain in 90% and macroscopic hematuria in 82.6%, 34% had renal dysfunction and 44.8% needed ureteroscopic treatment. In univariate analysis, chronic hepatitis C, a history of urolithiasis, prior use of indinavir, ATV duration, undetectable plasma HIV RNA, use of ritonavir as a booster and serum free bilirubin level were associated with ATV-urolithiasis. Multivariate models retained serum free bilirubin level (OR: 2.31, p<0.02) and either ATV duration (OR:  = 1.42, p = <0.03) or a history of urolithiasis (OR = 4.79, p<0.02) when adjusting on serum free bilirubin level as risk factors associated with urolithiasis.
  
  
  CONCLUSIONS
  ATV-containing urolithiasis are associated with frank clinical symptoms and may require surgical intervention. A high serum bilirubin level, a long exposure to ATV and a history of urolithiasis are risk factors for this rare adverse event.
authors.affiliation: Department of Infectious Diseases, Saint-Louis Hospital, Paris, France, and University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Lafaurie
authors.affiliation: Department of Infectious Diseases, Saint-Louis Hospital, Paris, France, and University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France.
authors.forename: Barbara
authors.initials: B
authors.lastname: De Sousa
authors.affiliation: Department of Infectious Diseases, Saint-Louis Hospital, Paris, France, and University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Ponscarme
authors.affiliation: AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale, Paris, France, and INSERM, UMR_S 1136, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Paris, France, and Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Paris, France.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Lapidus
authors.affiliation: Laboratory of Clinical Physiology, Tenon Hospital, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Daudon
authors.affiliation: AP-HP, Service of Clinical Immunology, Georges Pompidou European Hospital and University of Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Weiss
authors.affiliation: Department of Infectious Diseases, Bichat Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Rioux
authors.affiliation: Internal Medicine Department, Bicetre Hospital, Le Kremlin Bicetre, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Fourn
authors.affiliation: Department of Infectious Diseases, Pitie-Salpetriere Hospital, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.affiliation: Department of Infectious Diseases, Saint-Louis Hospital, Paris, France, and University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Molina
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069446:Atazanavir Sulfate; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects* / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D052878:Urolithiasis / Q000139:chemically induced*
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate