Relationships between Serum Levels of Atazanavir and Renal Toxicity or Lithiasis

Abstract

The main aim of this study is to describe the relationship between serum levels of atazanavir, renal toxicity, and lithiasis. This is a prospective observational study of patients being treated with atazanavir (ATV) at Son Espases Teaching Hospital, Palma de Mallorca, between 2011 and 2013. The study includes 98 patients. Sixteen were found to have a history of urolithiasis. During a median monitoring period of 23 months, nine patients suffered renal colic, in three of whom ATV crystals were evidenced in urine. Cumulative incidence of renal colic was 9.2 per 100 patients. The variables related to having renal colic were the presence of alkaline urine pH and lower basal creatinine clearance. The mean serum level of ATV was slightly higher in patients with renal colic—1,303 μg/L versus 1,161 μg/L—but did not reach statistical significance. Neither were any significant differences detected by analysing the levels according to the timetable for ATV dosage. Cumulative incidence of renal colic was high in patients being treated with ATV, in 33% of whom the presence of ATV crystals was evidenced in urine. We were unable to demonstrate a relationship between ATV serum levels and renal colic or progression towards renal failure.

Low incidence of advanced neurological burden but high incidence of age-related conditions that are dementia risk factors in aging people living with HIV: a data-linkage 10-year follow-up study

“…In this study, current treatment with abacavir, efavirenz, atazanavir, or darunavir containing regimen was associated with higher ARC burden. Previous studies have also reported the association between the use of certain ARV drugs and ARC including metabolic disorders (e.g., association between abacavir and cardiovascular events (Choi et al 2011;Worm et al 2010); relationship between efavirenz and decrease in vitamin D level and osteopenia (Childs et al 2012;Dave et al 2015); increased risk of chronic kidney disease and urolithiasis among those taking atazanavir (Marinescu et al 2015;Mocroft et al 2010); and association between darunavir and CVD) (Li et al 2020;Ryom et al 2018). Our findings, however, should be cautiously interpreted because the associations between these ARV drugs and ARC burden may not imply a causal relationship since the analysis was based on the current use rather than the cumulative use of these ARVs.…”

Renal effects of non-tenofovir antiretroviral therapy in patients living with HIV

“…The mean ATV level for those with urolithiasis was slightly higher (1303 vs 1161 mg/L) but did not reach statistical significance. Twelve patients (16.2%) met criteria for renal failure (eGFR <60 mL/min or eGFR decrease of 20 mL/min) and higher ATV plasma levels were not associated with renal failure [ 56 ]. Studies were conducted involving potential single nucleotide polymorphisms (SNPs) associated with ATV metabolism.…”

Renal stone composed of ritonavir

“…Previous studies have suggested that impaired hepatic function could result in increased renal elimination, as hepatic metabolism is important for many of these PIs 22–24. Other predisposing factors to stone formation include low water intake, alkaline urine, baseline diminished kidney function, history of urinary stones, and duration of medication exposure 25–29. Our patient had none of the first factors, although she did take ritonavir for approximately 4 years.…”