(Last updated: March 1, 2016; last reviewed: March 1, 2016)
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Urolithiasis/ Nephrolithiasis||ATV, IDV
Although DRV causes crystalluria, it is not associated with increased nephrolithiasis risk.
||ATV-related nephrolithiasis occurs in <10%.||In adults, elevated urine pH (>5.7)
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 3- to 6-month intervals. 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 measure 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.|
|Elevation in Serum Creatinine||DTG, COBI, RPV||Onset:
Need to distinguish between true change in GFR and other causes. True change might be associated with other medical conditions, continuing rise of serum creatinine with time, and albuminuria.
|N/A||Monitor serum creatinine. Assess for renal dysfunction if serum creatinine increases by >0.4 mg/dL or increases are ongoing with time.||No need to change therapy.
Reassure patient about the benign nature of the laboratory abnormality.
|Key to Acronyms: ARV = antiretroviral; ATV = atazanavir; COBI = cobicistat; ddI = didanosine; DRV = darunavir; DTG = dolutegravir; GFR = glomerular filtration rate; IDV = indinavir; LPV/r = boosted lopinavir/ritonavir; PI = protease inhibitor; RPV = rilpivirine; TDF = tenofovir disoproxil fumarate|