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HIV, drugs and the kidney
Nicola Wearne1, Bianca Davidson1, Marc Blockman2
1Groote Schuur Hospital Department of Medicine, Division of Nephrology and Hypertension, Nephrology and Hypertension Research Unit, University of Cape Town, South Africa.
Drugs in Context
|April 8, 2020
Summary
Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) can cause kidney injury and drug interactions. This review guides clinicians on adjusting ART drug doses for patients with impaired kidney function.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Over 36 million people globally live with HIV, with expanding Antiretroviral Therapy (ART) leading to increased drug exposure and interactions.
- Polypharmacy is common in people with HIV due to ART, opportunistic infections, and chronic diseases, increasing risks of drug toxicities.
- HIV infection itself elevates the risk of both acute kidney injury (AKI) and chronic kidney disease (CKD).
Purpose of the Study:
- To review the nephrotoxic effects of ART, including drug-drug interactions.
- To provide guidance for clinicians on adjusting ART drug dosages in patients with HIV and renal impairment, including those on dialysis.
Main Methods:
- Literature review of ART, nephrotoxicity, drug interactions, and renal impairment in HIV patients.
- Analysis of drug dosing considerations for commonly used ART medications in the context of reduced kidney function.
Main Results:
- Impaired renal function in HIV patients complicates drug management, affecting interactions, toxicities, and necessitating dose adjustments.
- ART and other medications contribute to AKI and CKD in the HIV population.
- Specific guidance on dose adjustments for commonly used ART drugs in renal impairment and dialysis is needed.
Conclusions:
- Clinicians must carefully manage ART in HIV patients with renal impairment due to increased risks of nephrotoxicity and drug interactions.
- Dose adjustments are crucial for effective and safe ART in patients with reduced kidney function.
- This review offers practical guidance for optimizing ART management in HIV-infected individuals with kidney disease.
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