One-third of HIV-positive patients with kidney problems at a University of Alabama, Birmingham clinic received incorrect nucleoside reverse transcript inhibitor (NRTI) prescriptions, according to a report published in the September 1 edition of Clinical Infectious Diseases and reviewed by AIDSmap. One patient experienced kidney failure and another a dangerous buildup of acid in the blood (lactic acidosis) as a result.
Researchers also found that multiple-drug pills such as Atripla (efavirenz plus tenofovir and emtricitabine) were associated with prescribing errors for patients with decreased kidney function, because the dosing of the NRTI components are fixed and cannot be regulated. Necessary dose reductions were more likely to be overlooked among African-American and older patients, who are already affected disproportionately by diseases that can damage the kidneys such as high blood pressure and diabetes.
Researchers also found patients at the Birmingham clinic whose dosages should have been adjusted for body weight, further evidence, they argued, that clinics need computer programs that can make NRTI dosing recommendations based on kidney function, body weight and what other kinds of medications are being taken.
