(Last updated: February 12, 2014; last reviewed: February 12, 2014)
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Urolithiasis/ nephrolithiasis||IDV, ATV||Onset:
||IDV-related nephrolithiasis is more common in adults (4%–43%) than in children (0%–20%).
ATV nephrolithiasis is rare.
|In adults, high serum IDV concentrations and elevated urine pH (>5.7) associated with persistent pyuria.
Unknown in children.
||Provide adequate hydration and pain control; consider using alternative ARV.|
||Risk May Be Increased in Children:
||Monitor urine protein and glucose or urinalysis, and serum creatinine at intervals of every 3–6 months. For patients taking TDF, some panelists add serum phosphate to the list of routine labs to monitor.
In the presence of persistent proteinuria or glucosuria, or for symptoms of bone pain or muscle pain or weakness, also monitor serum phosphate
Because toxicity risk increases with duration of TDF treatment, frequency of monitoring should not decrease with time. While unproven, routine monitoring intervals of every 3–6 months might be considered. Abnormal values should be confirmed by repeat testing, and frequency of monitoring can be increased if abnormalities are found and TDF is continued.
|If TDF is the likely cause, consider using alternative ARV.|
|IDV||Renal cortical atrophy, acute renal failure||Rare||Unknown||Unknown||If IDV is likely cause, consider using alternative ARV.
Note: IDV not FDA-approved for use in children.
|Key to Acronyms: ARV = antiretroviral;, ATV = atazanavir; ddI = didanosine; IDV = indinavir; LPV/r = ritonavir-boosted lopinavir; PI = protease inhibitor; TDF = tenofovir disoproxil fumarate|