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Highly Active Antiretroviral Therapy and the Kidney: An Update on Antiretroviral Medications for Nephrologists

Jeffrey S. Berns^*, and Nishaminy Kasbekar

^* Renal, Electrolyte and Hypertension Division, Department of Medicine, and Department of Pharmacy, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania

Address correspondence to: Dr. Jeffrey S. Berns, Penn Presbyterian Medical Center, 51 N. 39th Street, Medical Office Building #240, Philadelphia, PA 19104. Phone: 215-662-8730; Fax: 215-243-4686; E-mail: bernsj{at}uphs.upenn.edu

Highly active antiretroviral therapy has dramatically altered the treatment and life expectancy of individuals who are infected with HIV. More than 20 antiretroviral drugs and drug combinations now are available in the United States. Nephrologists need to have an understanding of the pharmacokinetics of antiretroviral medications and the proper dosing of these medications in patients with impaired kidney function. It is also important for nephrologists to be aware of drug–drug interactions that can occur between antiretroviral medications and other medications that they may prescribe, including immunosuppressive medications that are used for renal transplantation, as this becomes more common in HIV-infected patients. Adverse reactions that affect the kidneys and cause fluid-electrolyte complications occur with certain antiretroviral agents, although most are relatively free of nephrotoxicity. This article reviews the clinical pharmacology and dosing modifications of the newer antiretroviral medications in patients with reduced kidney function; important drug–drug interactions involving these medications, particularly with other medications that are likely to be prescribed by nephrologists; and renal toxicities of antiretroviral agents.