AIDS Treatment Update, Issue 65, May 1998

"Kidney stones and crystals in the urine are a consequence of very high levels of a breakdown product of indinavir accumulating in the urine," said Dr Churchill.

"The highest concentration of the crystallised metabolite in the urine is present one to two hours after taking indinavir, so this is the time to drink a lot of fluid. We have observed that the problem is much more likely to occur after the night time dose because people don't want to drink too much water before bedtime."

Kidney stones are the most severe problem associated with indinavir "sludge", as some doctors have labelled the breakdown product. Kidney stones affected 1-2% of people in clinical trials of indinavir, but Dr Churchill points out that up to 20% of people in these studies had crystallised indinavir in their urine (crystalluria) after 28 weeks of treatment. Pain on passing urine is likely to be a signal that the tiny, sharp crystals are building up in your urine, and that you should drink more fluid at the same time as each indinavir dose.

Although the possibility of twice daily indinavir dosing has been highlighted by recent studies, Dr Churchill warned that this could increase the risk of these side-effects, as could the indinavir dose increases required when indinavir is combined with nevirapine or efavirenz (DMP-266).

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