HIV, drugs and the kidney

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Nicola Wearne MBChB, FCP, MMed, Bianca Davidson MBChB, FCP, MMed, Marc Blockman MBChB, BPharm, PG Dip Int Res Ethics, MMed, Annoesjka Swart BScPharm, Erika SW Jones MBBCh, FCP, PhD

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Human immunodeficiency virus (HIV) affects over 36 million people worldwide. Antiretroviral therapy (ART) is expanding and improving HIV viral suppression, resulting in increasing exposure to drugs and drug interactions. Polypharmacy is a common complication as people are living longer on ART, increasing the risk of drug toxicities. Polypharmacy is related not only to ART exposure and medication for opportunistic infections, but also to treatment of chronic lifestyle diseases. Acute kidney injury (AKI) is frequent in HIV and is commonly the result of sepsis, dehydration and drug toxicities. Furthermore, HIV itself increases the risk of chronic kidney disease (CKD). Drug treatment is often complicated in people living with HIV because of a greater incidence of AKI and/or CKD compared to the HIV-negative population. Impaired renal function affects drug interactions, drug toxicities and importantly drug dosing, requiring dose adjustment. This review discusses ART and its nephrotoxic effects, including drug–drug interactions. It aims to guide the clinician on dose adjustment in the setting of renal impairment and dialysis, for the commonly used drugs in patients with HIV.

Keywords: drugs interactions, HIV, kidney injury, nephrotoxicity, renal dose adjustment.

Citation: Wearne N, Davidson B, Blockman M, Swart A, Jones ESW. HIV, drugs and the kidney. Drugs in Context 2020; 9: 2019-11-1. DOI: 10.7573/dic.2019-11-1

Contributions: NW, BD and EJ contributed equally to the design and writing of the manuscript. MB and AS reviewed and edited the manuscript and compiled the tables. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2020 Wearne N, Davidson B, Blockman M, Swart A, Jones ESW. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Wearne N, Davidson B, Blockman M, Swart A, Jones ESW. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL:,-drugs-and-the-kidney/

Correspondence: Erika Jones, E13 Renal Unit, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa.

Provenance: invited; externally peer reviewed.

Submitted: 4 November 2019; Peer review comments to author: 21 November 2019; Revised manuscript received: 18 January 2020; Accepted: 11 February 2020; Publication date: 10 March 2020.

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