Renal effects of non-tenofovir antiretroviral therapy in patients living with HIV

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Milena M McLaughlin PharmD, MSc, Aimee J Guerrero BS, Andrew Merker PharmD

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A review of literature published regarding non-tenofovir antiretroviral agents causing renal adverse effects was conducted. The literature involving renal adverse effects and antiretroviral therapy is most robust with protease inhibitors, specifically atazanavir and indinavir, and includes reports of crystalluria, leukocyturia, nephritis, nephrolithiasis, nephropathy and urolithiasis. Several case reports describe potential nephropathy (including Fanconi syndrome) secondary to administration of abacavir, didanosine, lamivudine and stavudine. Case reports documented renal events such as acute renal failure, nephritis, proteinuria and renal stones with efavirenz administration. Regarding rilpivirine, a small increase of serum creatinine levels (SCr) was found in clinical trials; however, the clinical significance and impact on actual renal function is unknown. The integrase strand transfer inhibitors and enfuvirtide have a relatively safe renal profile, although studies have shown dolutegravir and raltegravir cause mild elevations in SCr without an impact on actual renal function. This is similar to the reaction observed with cobicistat, the pharmacokinetic enhancer frequently given with elvitegravir.

Keywords: anti-HIV agents, antiretroviral therapy, highly active, HIV infections, kidney, kidney diseases, nephrolithiasis, urolithiasis.

Citation: McLaughlin MM, Guerrero AJ, Merker A. Renal effects of nontenofovir antiretroviral therapy in patients living with HIV. Drugs in Context 2018; 7: 212519. DOI: 10.7573/dic.212519

Disclosure and potential conflicts of interest: The authors report no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at

Funding declaration: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Copyright: Copyright © 2018 McLaughlin MM, Guerrero AJ, Merker A. 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 © 2018 McLaughlin MM, Guerrero AJ, Merker A. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Milena McLaughlin, PharmD, MSc, Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.

Provenance: invited; externally peer reviewed.

Submitted: 1 December 2017; Peer review comments to author: 15 January 2018; Revised manuscript received: 22 February 2018; Accepted: 22 February 2018; Publication date: 21 March 2018.

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