Kalyesubula Robert, Perazella Mark A
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampal, Uganda.
AIDS Res Treat. 2011;2011:562790. doi: 10.1155/2011/562790. Epub 2011 Aug 15.
Highly active antiretroviral therapy (HAART) and other medical therapies for HIV-related infections have been associated with toxicities. Antiretroviral therapy can contribute to renal dysfunction directly by inducing acute tubular necrosis, acute interstitial nephritis, crystal nephropathy, and renal tubular disorders or indirectly via drug interactions. With the increase in HAART use, clinicians must screen patients for the development of kidney disease especially if the regimen employed increases risk of kidney injury. It is also important that patients with chronic kidney disease (CKD) are not denied the best combinations, especially since most drugs can be adjusted based on the estimated GFR. Early detection of risk factors, systematic screening for chronic causes of CKD, and appropriate referrals for kidney disease management should be advocated for improved patient care. The interaction between immunosuppressive therapy and HAART in patients with kidney transplants and the recent endorsement of tenofovir/emtricitabine by the Centers for Disease Control (CDC) for preexposure prophylaxis bring a new dimension for nephrotoxicity vigilance. This paper summarizes the common antiretroviral drugs associated with nephrotoxicity with particular emphasis on tenofovir and protease inhibitors, their risk factors, and management as well as prevention strategies.
高效抗逆转录病毒疗法（HAART）及其他针对HIV相关感染的药物治疗都存在毒性。抗逆转录病毒疗法可通过诱发急性肾小管坏死、急性间质性肾炎、结晶性肾病及肾小管疾病直接导致肾功能障碍，或通过药物相互作用间接引发。随着HAART使用的增加，临床医生必须对患者进行肾病发生情况的筛查，尤其是在采用的治疗方案会增加肾损伤风险时。同样重要的是，慢性肾病（CKD）患者不应被拒绝使用最佳药物组合，特别是因为大多数药物可根据估算的肾小球滤过率进行调整。应提倡早期发现危险因素、系统性筛查CKD的慢性病因以及对肾病管理进行适当转诊，以改善患者护理。肾移植患者中免疫抑制疗法与HAART之间的相互作用，以及疾病控制中心（CDC）最近对替诺福韦/恩曲他滨用于暴露前预防的认可，为肾毒性监测带来了新的层面。本文总结了与肾毒性相关的常见抗逆转录病毒药物，特别强调了替诺福韦和蛋白酶抑制剂、它们的危险因素、管理以及预防策略。
