WESTPORT, CT (Reuters Health) Oct 17 - Indinavir-associated renal
complications might be reduced by careful attention to such preventable
factors as dehydration, according to a report from the September issue of the
Journal of Antimicrobial Chemotherapy.
Indinavir-associated renal complications range from asymptomatic crystalluria
to severe renal colic from nephrolithiasis, the authors explain, but the
actual incidence of such complications has not been studied in a large
Dr. Philippa J. Easterbrook from King's College Hospital in London, UK and
colleagues analyzed the incidence and risk factors of indinavir-associated
renal complications (IRC) in 781 patients from two large HIV centers in
"This study represents the largest and most comprehensive analysis to date of
risk factors for the development of IRC," the investigators write.
Fifty-seven patients (7.3%) experienced IRC after a median 37 weeks of
treatment with indinavir, the authors report, a rate only slightly higher
than that reported from clinical trials (2.5% to 5%).
More than a quarter of cases (15 patients) had an identifiable precipitant,
the report indicates, including events likely to lead to fluid depletion
(10), changes in indinavir dose from 800 mg three times daily to 1200 mg
twice daily (4), and inadvertent overdose (1).
IRC was also associated with increasing duration of treatment with indinavir,
the researchers note. Moreover, the concomitant use of acyclovir increased
the risk of IRC by 76%.
Nearly two thirds of the patients required hospitalization for IRC, the
results indicate, but only 14 (39%) required urological intervention and only
7 patients (12%) required permanent cessation of indinavir therapy.
The authors conclude that careful monitoring for common precipitants,
particularly during concomitant use of acyclovir, might prevent many cases of
J Antimicrob Chemother 2001;48:355-360.