HIV/AIDS case histories: indinavir crystalluria

[Indinavir urolithiasis in HIV-positive patients. Treatment and prophylaxis]

TARGET

The approximate incidence of indinavir urolithiasis in HIV positive patients receiving the drug is 10%. The exact mechanism of lithogenesis is still unknown. Pure indinavir stones are radiolucent on plane abdominal X-ray or CT scan. Indinavir urolithiasis can be associated with acute unilateral renal colic or severe azotaemia.

MATERIAL AND METHODS

20 HIV patients were treated conservatively by increasing oral fluid intake (urine production of 2 l/day and more), discontinuation of indinavir therapy for 1 week and acidification of urine with l-methionin (urine pH 5,3-5,8). Some patients were additionally treated with endoscopic procedures.

RESULTS

In all patients renal function normalized. Increase of oral fluid intake, especially during the first 2 hours after intake of indinavir and during night prevented recurrence of indinavir urolithiasis.

CONCLUSION

HIV positive patients with renal colic or renal insufficiency and roentgenological absence of radio-opaque stone formations should make the urologist consider indinavir urolithiasis as a possible diagnosis.

Treatment of indinavir sulfate induced urolithiasis in HIV-positive patients

Indinavir sulfate is a protease inhibitor used of the treatment of primary HIV infection either as monotherapy or as part of antiretroviral treatment schemes. Approximately 10% of all patients develop urolithiasis with radiolucent stones consisting of indinavir. We present our results of the treatment in 11 HIV positive patients (9 men, 2 women), who developed Indinavir lithiasis after 5-8 months of antiretroviral therapy. Following the initial procedures (spasmoanalgetic drugs, ureteroscopy, double J-stent or nephrostomy), the patients were further treated by increasing diuresis and urinary acidification. All the patients responded well to the treatment, the obstruction was releieved and their renal function was restored to normal.