Antiviral therapy for HIV patients with renal insufficiency

Patients with HIV infection and HIV-related opportunistic infections are he ated extensively with a spectrum of drugs. Introduction of new antiretrovir al drugs, such as protease inhibitors and nonnucleoside reverse transcripta se inhibitors in addition to nucleoside reverse transcriptase inhibitors, h as created exciting dimensions in treatment strategies. Renal dysfunction i s also common in HIV-infected patients. Because some drugs used in HIV are primarily excreted unchanged by the kidney, dose adjustments are necessary in patients with renal insufficiency. Drugs such as fosearnet, cidofovir an d adefovir are directly nephrotoxic, whereas acyclovir can crystallize in t he kidneys, and indinavir may cause nephrolithiasis. This paper reviews the impact of renal insufficiency on pharmacokinetics of antiviral drugs used in HIV disease and discusses dosage recommendations needed to avoid toxicit y. Finally, we summarize the effects of dialysis on removal of these drugs.