ART and Nephrolithiasis — SCE Infectious Diseases MCQ

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ModerateHIV MedicineART and NephrolithiasisSCE Infectious Diseases

A 34-year-old man with HIV (CD4 530, VL <50 on DTG/TAF/FTC) develops new-onset renal colic. CT KUB shows a 6 mm radio-opaque ureteric calculus. He is not on any other medications. Which ART component can rarely cause nephrolithiasis?

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Correct answer: C — Atazanavir — though not in this patient's current regimen, it is the PI most associated with renal calculi; his current INSTI-based regimen does not typically cause stones

Among ARV agents, Atazanavir (a PI) is most associated with nephrolithiasis — the drug crystallises in alkaline urine. Indinavir historically caused stones frequently. Current first-line agents (DTG, BIC, TAF, FTC) are not associated with renal calculi. This patient's stone is likely unrelated to ART — standard urological investigation (stone analysis, metabolic workup) should proceed. The question tests knowledge of ART-specific adverse effects and the ability to identify when a presentation is NOT drug-related.

Reference: BHIVA 2025 – ART adverse effects; BNF 2024 – Atazanavir