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Viread China Syndrome?

Posted: Aug 1, 2004

QUESTION:

I work with a challenging population of incarcerated patients. Many carry multiple diagnoses as well as HIV/AIDS. I have recently had two patients who developed fulminant renal failure while on Viread. It occurs to me that (1) as Viread is renally excreted (witness the recommended dosage adjustments in renal compromise)and (2) new additions to the official labeling note that increased adverse effects including renal toxicities may be associated with increased blood levels we may have a positive feedback situation. Unnoticed renal compromise causes decreased excretion leading to increased blood levels leads to additional renal compromise and so on. Any thoughts?


  

RESPONSE FROM:   

    My thoughts concur with your thoughts. I think that renal issues with Viread are very uncommon in patients with normal renal function. But for individuals with baseline compromised kidney function, levels may build up and lead to renal dysfunction. This in turn triggers higher levels and produces an escalating spiral of renal damage.

    Luckily, this does not happen often. At the recent International AIDS Conference in Bangkok there were several reports showing very low rates of kidney side effects related to Viread in real world practices. But I think it is crucial that clinicians make proper dosage adjustments for patients on Viread that have borderline renal function.




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