Treatment for kidney toxicity

In most patients, kidney impairment due to antiretroviral therapy resolves within a few weeks after the drug(s) responsible are discontinued or dose adjusted. However, in some cases, drug toxicity may lead to permanent kidney damage, as has been reported with cidofovir (Vistide) and amphotericin (Fungilin / Fungizone / Abelcet / AmBisome / Amphocil). More recently, many patients who discontinued tenofovir (Viread) due to renal toxicity were shown to have persistent kidney damage (as indicated by reduced GFR) more than one year after discontinuing the drug.¹

Most kidney stones are passed during urination, although this may require painkillers. In more severe cases, surgery may be required. Because indinavir kidney stones have a gelatinous texture, unlike harder calcium stones, they do not show up well on regular X-rays and cannot be broken apart by shock waves. After kidney stones are eliminated, most patients can safely restart indinavir as long as they maintain adequate fluid intake.

In cases of serious kidney impairment, treatment may be provided to increase hydration, boost phosphate levels, or reduce blood pressure. If kidney failure develops, haemodialysis may be required. This involves filtration of the blood by a dialysis machine that takes over the function of the kidneys. Dialysis is a viable option for HIV-positive individuals, but requires dose adjustments of certain antiretroviral drugs.

Kidney transplantation is another possible option for patients with end-stage renal disease. Recent studies have shown that with improved antiretroviral therapy, HIV-positive patients now have a post-transplant success rate similar to that of HIV-negative people.² One study found that HIV-positive patients who received kidney transplants were more likely to survive for up to two years longer than those who remained on haemodialysis.³