Assessments of liver function (LFTs) should include ALT and/or AS

Assessments of liver function (LFTs) should include ALT and/or AST, ALP, GGT, bilirubin and albumin, and should be performed at baseline, routine clinic visits and during illness (IIa). More frequent monitoring is recommended during the first 3 months of exposure to (new) antiretrovirals (except nevirapine; see below), at approximately 1 month and 3 months (III). More frequent monitoring of LFTs (every 2 weeks during the first 2 months of treatment, at the third month, and then regularly thereafter) is recommended in the summary of product characteristics (SPC) for nevirapine. Patients with persistently raised markers of liver injury LEE011 or

newly occurring abnormal liver tests should be investigated for viral hepatitis, opportunistic infection, malignancy, drug toxicity or fatty liver disease (IIa). Sporadic high ALT levels are common. Apparent elevations should be confirmed (III). Acute hepatitis C should be excluded if an appropriate exposure history is obtained. Kidney disease may affect up to 30% of HIV-infected patients. Acute renal Topoisomerase inhibitor failure is largely restricted

to hospitalized patients with infection, liver disease or malignancy [4]. Chronic kidney disease (CKD) is associated with advanced HIV infection, older age, diabetes mellitus, hypertension and use of indinavir or tenofovir [5, 6]. In Black patients, HIV-associated nephropathy (HIVAN) is an important cause of CKD and typically presents with heavy proteinuria and advanced renal failure at HIV diagnosis [7]. In other ethnicities, most CKD is associated with metabolic, vascular or urological disease, and drug toxicity [6]. The prognosis of Black patients with HIV-associated

chronic kidney disease has improved dramatically in the HAART era, and the number of patients requiring long-term renal replacement has risen considerably in recent years [8]. CKD may be diagnosed by the presence of haematuria, proteinuria or reduced estimated glomerular filtration rate (eGFR) for more than 3 months [9]. Use of creatine supplements as a possible explanation for raised serum creatinine levels (and reduced eGFR) should be excluded. Proteinuria is a risk factor for developing renal failure [10] and (cardiovascular) death [11]. Patients with severe renal impairment, progressive decline in renal function, persistent haematuria or significant proteinuria Montelukast Sodium (above 500 mg/24 h) should be investigated to establish the aetiology. ART may slow the progression of CKD, at least in patients with HIVAN [12, 13]. Although most antiretroviral drugs may cause renal injury, indinavir and tenofovir have been most frequently associated with nephrotoxicity [14]. Crystallization of indinavir in the urinary tract may result in nephrolithiasis or tubulo-interstitial nephritis. Most episodes resolve with rehydration and drug discontinuation, although gradual loss of renal function and progressive or irreversible renal failure have also been reported [14].

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