Acute Kidney Injury Associated With Lopinavir/Ritonavir Combined Therapy in Patients With COVID-19

Lopinavir and low-dose ritonavir (LPV/RTV) are associated in a fixed-dose combination protease inhibitor therapy used in patients with HIV and AIDS. The recent outbreak of severe acute respiratory syndrome coronavirus 2 infections causing coronavirus disease 2019 (COVID-19) has rekindled the interest in LPV/RTV after preclinical studies.1 Although no benefit was observed with LPV/RTV treatment beyond standard care,2 other randomized controlled trials, such as DisCoVeRy (NCT04315948), are currently enrolling. Like other antiretroviral therapies, LPV/RTV has been previously associated with acute kidney injuries (AKIs), even though no systematic pharmacovigilance analysis was ever performed.We first describe a small case series of AKI associated with LPV/RTV in the course of COVID-19 treatment. We then performed a query in the World Health Organization pharmacovigilance database, VigiBase, and extracted all AKIs associated with LPV/RTV. We then presented clinical characteristics of these events and performed a comparison between HIV and COVID-19 indication in VigiBase.