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Kidney Disease and the start od HIV medications Posted: Jun 1, 2006 QUESTION: I work with a client who has been HIV positive since 1997. He has never taken HIV medications and began dialysis for kidney failure in 1998. In September 2005, he finally resumed medical care for his HIV and was advised to begin HIV medications due to a viral load of 100,000. He declined medications because he is concerned about the side effects of HIV meds will have on the progression of his kidney failure. Is there a medication regimen that would be deemed "okay" for his condition? I would like to discuss these options with him and provide additional information to assist client in making an informed decision.


RESPONSE FROM: IF he is on dialysis the issue of nephrotoxicity is really moot. Further damamge will not be an issue. In the patient with renal impairment there are two major considerations regarding HIV therapy: dosing and nephrotoxicity. Dosing for varying degrees of renal insufficiency have been devisd for 3TC, FTC and tenofovir. As far as renal toxicity, all HIV therapies are fairly safe. Indinavir can cause nephrolithiasis that can complicate renal function. Tenofovir has been linked to a small change in creatinine clearance over time in patients with advanced HIV infection (J Gallant, et al. Clinical Infectious Diseases, 2005). However, the clinical relevance of such a change remains to be determined. DW

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