Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Management of Medication Toxicity or Intolerance

Nephrotoxic Effects

Last Updated: April 14, 2020; Last Reviewed: April 14, 2020


  1. Andiman WA, Chernoff MC, Mitchell C, et al. Incidence of persistent renal dysfunction in human immunodeficiency virus-infected children: associations with the use of antiretrovirals, and other nephrotoxic medications and risk factors. Pediatr Infect Dis J. 2009;28(7):619-625. Available at:
  2. Judd A, Boyd KL, Stohr W, et al. Effect of tenofovir disoproxil fumarate on risk of renal abnormality in HIV-1-infected children on antiretroviral therapy: a nested case-control study. AIDS. 2010;24(4):525-534. Available at:
  3. Nachman SA, Chernoff M, Gona P, et al. Incidence of noninfectious conditions in perinatally HIV-infected children and adolescents in the HAART era. Arch Pediatr Adolesc Med. 2009;163(2):164-171. Available at:
  4. Riordan A, Judd A, Boyd K, et al. Tenofovir use in human immunodeficiency virus-1-infected children in the United kingdom and Ireland. Pediatr Infect Dis J. 2009;28(3):204-209. Available at:
  5. Soler-Palacin P, Melendo S, Noguera-Julian A, et al. Prospective study of renal function in HIV-infected pediatric patients receiving tenofovir-containing HAART regimens. AIDS. 2011;25(2):171-176. Available at:
  6. van Rossum AM, Dieleman JP, Fraaij PL, et al. Indinavir-associated asymptomatic nephrolithiasis and renal cortex atrophy in two HIV-1 infected children. AIDS. 2001;15(13):1745-1747. Available at:
  7. Purswani M, Patel K, Kopp JB, et al. Tenofovir treatment duration predicts proteinuria in a multiethnic United States cohort of children and adolescents with perinatal HIV-1 infection. Pediatr Infect Dis J. 2013;32(5):495-500. Available at:
  8. Nishijima T, Hamada Y, Watanabe K, et al. Ritonavir-boosted darunavir is rarely associated with nephrolithiasis compared with ritonavir-boosted atazanavir in HIV-infected patients. PLoS One. 2013;8(10):e77268. Available at:
  9. de Lastours V, Ferrari Rafael De Silva E, Daudon M, et al. High levels of atazanavir and darunavir in urine and crystalluria in asymptomatic patients. J Antimicrob Chemother. 2013;68(8):1850-1856. Available at:
  10. German P, Liu HC, Szwarcberg J, et al. Effect of cobicistat on glomerular filtration rate in subjects with normal and impaired renal function. J Acquir Immune Defic Syndr. 2012;61(1):32-40. Available at:
  11. Lim Y, Lyall H, Foster C. Tenofovir-associated nephrotoxicity in children with perinatally-acquired HIV infection: a single-centre cohort study. Clin Drug Investig. 2015;35(5):327-333. Available at:
  12. Samarawickrama A, Cai M, Smith ER, et al. Simultaneous measurement of urinary albumin and total protein may facilitate decision-making in HIV-infected patients with proteinuria. HIV Med. 2012;13(9):526-532. Available at:
  13. Marcelin JR, Berg ML, Tan EM, Amer H, Cummins NW, Rizza SA. Is abnormal urine protein/osmolality ratio associated with abnormal renal function in patients receiving tenofovir disoproxil fumarate? PLoS One. 2016;11(2):e0149562. Available at:
  14. Lin KY, Liao SH, Liu WC, et al. Cholelithiasis and sephrolithiasis in HIV-positive patients in the era of combination antiretroviral therapy. PLoS One. 2015;10(9):e0137660. Available at:
  15. Bunupuradah T, Phupitakphol T, Sophonphan J, et al. Prevalence of persistent renal dysfunction in perinatally HIV-infected Thai adolescents. Pediatr Infect Dis J. 2018;37(1):66-70. Available at:
  16. Purswani MU, Patel K, Winkler CA, et al. Brief report: APOL1 renal risk variants are associated with chronic kidney disease in children and youth With perinatal HIV infection. J Acquir Immune Defic Syndr. 2016;73(1):63-68. Available at:
  17. Soares DS, Cavalcante MG, Ribeiro SM, et al. Acute kidney injury in HIV-infected children: comparison of patients according to the use of highly active antiretroviral therapy. J Pediatr (Rio J). 2016;92(6):631-637. Available at:
  18. Brunel V, Massy N, Malval B. Atazanavir urolithiasis without recent intake of atazanavir. Ann Biol Clin (Paris). 2019;77(4):459-460. Available at:
  19. Ekulu PM, Nkoy AB, Betukumesu DK, et al. APOL1 risk genotypes are associated with early kidney damage in children in sub-saharan Africa. Kidney Int Rep. 2019;4(7):930-938. Available at:
  20. Gupta SK, Post FA, Arribas JR, et al. Renal safety of tenofovir alafenamide vs tenofovir disoproxil fumarate: a pooled analysis of 26 clinical trials. AIDS. 2019;33(9):1455-1465. Available at:

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