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No recurrence occurred in 5 of the 6 patients who continued to receive the atazanavir therapy [36]. From December 2002 to January 2007, the US FDA's Adverse Event Reporting System identified 30 cases of nephrolithiasis in HIV-infected patients taking an atazanavir-based regimen [32]. Five patients (17%) had underlying liver disease: four patients had hepatitis C and one patient had hepatitis B. Three patients had pre-existing renal disease and five patients (17%) had a history of nephrolithiasis. Of the 20 cases reporting complete antiretroviral information, 13 patients received concomitant therapy with tenofovir and 17 patients received 100 mg of ritonavir. Among 14 cases reporting Bortezomib mouse stone analysis, 12 had atazanavir confirmed by infrared spectrophotometry or other analysis. In six cases, atazanavir concentrations in the stone ranged from 40 to 100%. In 17 cases with a complete atazanavir treatment Amrinone history, the median time between atazanavir initiation and the onset of nephrolithiasis was 1.7 years (ranged from 5 weeks to 6 years). Many patients required hospitalization for management, including lithotripsy, ureteral stent insertion or endoscopic stone removal. Five patients developed renal insufficiency (four with acute renal insufficiency and one with a worsening of baseline chronic renal insufficiency) at the time of nephrolithiasis. In all the four cases of acute renal insufficiency, renal function returned to baseline after stone removal and atazanavir discontinuation. In the patient who developed a worsening of baseline chronic renal insufficiency, renal function improved but had not returned to its previous baseline after stone removal. Of the 30 cases, atazanavir was reported as discontinued in 9 cases (30%) after nephrolithiasis was diagnosed [32]. A report based only on radiological findings compared the incidence of renal stones among patients receiving ATV/r and those receiving other antiretrovirals [34]. The reported incidence of ATV/r-induced renal stones was much lower (7.3 cases per 1000 person-years), compared with 23.7 cases per 1000 person-years in Hamada's study [35]. In this last study, renal stones were diagnosed in 31 patients (23.7 cases per 1000 person-years) in the ATV/r group (n = 465) Selleck SCH772984 and in 4 patients (2.2 cases per 1000 person-years) in the other PI group (n = 775). ATV/r use was significantly associated with renal stones in multivariable analysis [adjusted hazard ratio, 10.44; 95% confidence interval (CI), 3.685�C29.59; P