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HIV/AIDS Adverse Drug Reaction: Indinavir decreases nitric oxide production in HIV/AIDS patients


-- Indinavir decreases nitric oxide production in HIV/AIDS patients.

According to a recently published report from Brazil, "Treatment with indinavir (IDV), a protease inhibitor, is frequently associated with renal abnormalities.

"We determined the incidence of renal failure (creatinine clearance <80 mL min-1 1.73 (m2)-1) in HIV patients treated with highly active antiretroviral therapy, including IDV, and investigated the possible mechanisms and risk factors of IDV nephrotoxicity."

"Thirty-six patients receiving IDV were followed for 3 years. All were assessed for age, body weight, duration of infection, duration of IDV treatment, sulfur-derivative use, total cholesterol, triglycerides, magnesium, sodium, potassium, creatinine, and urinalysis.

"We also determined renal function in terms of creatinine clearance, urine osmolality and fractional excretion of sodium, potassium, and water. Urinary nitrate (NO3) excretion was measured in 18 IDV-treated patients and compared with that of 8 patients treated with efavirenz, a drug without renal side effects," investigators wrote.

M. Eira and colleagues at the University of Sao Paulo reported, "Sterile leukocyturia occurred in 80.5% of the IDV-treated patients. Creatinine clearance <80 mL min-1 1.73 (m2)-1 was observed in 22 patients (61%) and was associated with low body weight and the use of sulfur-derivatives.

"These patients also had lower osmolality, lower urine volume and a higher fractional excretion of water compared to the normal renal function group. Urinary NO3 excretion was significantly lower in IDV-treated patients (809±181 mcM NO3-/mg creatinine) than in efavirenz-treated patients (2247±648 mcM NO3-/mg creatinine, p<0.01)."

The authors concluded, "The lower NO3 excretion suggests that IDV decreases nitric oxide production."

Eira and colleagues published their study in Brazilian Journal of Medical and Biological Research (Urinary NO3 excretion and renal failure in indinavir-treated patients. Braz J Med Biol Res. 2006 Aug;39(8):1065-70).

For more information, contact M. Eira, Institute Infectol Emilio Ribas, Coordenadoria Service Saude, Secretaria Estado Saude, Av Dr. Arnaldo 165, BR-01246900 Sao Paulo, Brazil.

Publisher contact information for the Brazilian Journal of Medical and Biological Research is: Association Bras Divulg Cientifica, Faculdade Medicina, Sala 21, 14049 Ribeirao Preto, Sao Paulo, Brazil.

Keywords: Sao Paulo, Brazil, HIV/AIDS, Indinavir, Nephrotoxicity, Renal Failure, Urinary NO3 Secretion.

This article was prepared by AIDS Weekly editors from staff and other reports.


Eira M, Araujo M, Seguro AC., “Urinary NO3 excretion and renal failure in indinavir-treated patients”, Braz J Med Biol Res. 2006 Aug;39(8):1065-70.

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Information in this article was accurate in October 30, 2006. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.