High Prevalence of Indinavir-Associated Renal Complications in Thai HIV-Infected Patients
Anchalee Avihingsanon MD*, Yingyos Avihingsanon MD**, Praniti Darnpornprasert MD**, Stephen Kerr MD*,***, Chaiwat Ungsedhapand MD*, Chris Duncombe MD*,***, Sasiwimol Ubolyam MD*, Kiat Ruxrungtham MD*,**, Praphan Phanuphak MD*,****
Affiliation : * HIV-NAT study team, Thai Red Cross AIDS Research Centre ** Department of Medicine, Faculty of Medicine, Chulalongkorn University *** National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia **** Thai Red Cross AIDS Research Centre
Background : Indinavir (IDV) is the protease inhibitor (PI) used most often in resource-limited countries. The
present study aimed to determine the prevalence of IDV-associated renal complications as well as their
clinical characteristics.
Materials and Methods : The authors reviewed all patients participating in cohorts of indinavir-containing
regimens at the HIV-NAT research center during the period of indinavir treatment. Patients who had pre-
existing renal diseases were excluded. Renal toxicities included presence of urologic symptoms, nephrolithi-
asis, abnormal urine sediments, crystalluria and loss of renal function. Radiological studies of KUB system
were reviewed as well.
Results : Two-hundred and four patients treated with IDV were included. Median (IQR) follow up period was
216 (150-312) weeks. One hundred and eighty patients were treated with ritonavir-boosted regimens at some
point, and 24 patients were treated only with unboosted regimens. Leukocyturia (51.9%) was the most
common finding of IDV-associated renal complications. Thirty-five percent of patients had urologic symptoms
such as flank pain or dysuria. Almost half of the patients had significant loss of renal function that was
associated with prolonged use of IDV. The most common radiological finding was nephrolithiasis. Less com-
mon, but of greater clinical importance, are nephrocalcinosis or renal atrophy.
Conclusion : A high prevalence of IRC was found in Thai HIV-infected patients. As long as no other cost-
effective boosted PI regimens are available, strategies to prevent irreversible loss of renal function are
warranted.
Keywords : Indinavir, Nephrotoxicity, Nephrolithiasis, Nephrocalcinosis
