Severe Acute Kidney Injury and Double Tubulopathy Due to Dual Toxicity Caused by Combination Antiretroviral Therapy

Widespread use of combined antiretroviral therapy (cART) has reduced morbidity and mortality of HIV-infected patients, increasing life expectancy and quality of life.1 Despite this success, kidney disease remains a problem in this population with cART associated with both acute kidney injury (AKI) and chronic kidney disease (CKD)2,S1 The incidence of AKI in HIV outpatients ranges from 2.7 to 6.9 per 100 person-years, whereas hospital-related AKI is between 6% and 18%.2 AKI is commonly multifactorial, with volume depletion, sepsis, and drug nephrotoxicity the most frequent etiologies.2, 3 Drug-induced nephrotoxicity accounts for up to 30% of AKI episodes in critically ill patients.S2 There is increasing evidence that cART can lead to a wide variety of nephrotoxic effects and mild to severe AKI.4 Many factors contribute to drug-induced AKI in patients with HIV2; the most frequent mechanisms of cART nephrotoxicity are summarized in Table 1.2 Table 1 Causes of AKI in HIV-positive patients and manifestations of antiretroviral toxicity2