Treatment for human immunodeficiency virus with indinavir may cause relevant urological side-effects, effectively treatable by rehydration

Objective To explore the occurrence of, and diagnostic and therapeutic proc edures for urological side-effects (e.g. micro- and macrohaematuria, and ki dney stone formation) in individuals treated with indinavir for the human i mmunodeficiency virus (HIV). Patients and methods The study comprised a retrospective follow-up of 74 in dividuals infected with HIV-1 and who were treated with indinavir orally at a daily dose of 2.4 g. Data were collected at the outpatient department of our institution between March 1996 and November 1997. Results Of the 74 individuals treated with indinavir, 15 (20) had indinavir -related urological side-effects (19 episodes), most commonly dull flank pa in and dysuria. Microhaematuria occurred in 16 of the 19 episodes. Four pat ients showed urinary tract distension ultrasonographically as a possible in direct sign of urolithiasis and one patient passed a kidney stone. In four patients treatment had to be stopped permanently, but in the remaining 11 p atients treatment was continued. Some patients required dose reduction and/ or interruption of treatment; only conservative therapeutic measures were r equired, consisting of rehydration (fluid intake >1.5 L/day) and analgesics . Conclusions Urological side-effects of indinavir may be apparent in 20% of patients so treated: some (5%) may require permanent withdrawal, in additio n to a history and clinical examination, urine analysis and ultrasonography were the only diagnostic procedures required. Therapy is mainly conservati ve, using rehydration, analgesics and a brief discontinuation of therapy, a ccording to the severity of the symptoms.