Tenofovir Effect on the Kidneys of HIV-Infected Patients
Open Access
- 1 October 2013
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Society of Nephrology
- Vol. 24 (10), 1519-1527
- https://doi.org/10.1681/asn.2012080857
Abstract
Tenofovir disoproxil fumarate (TDF), the first nucleotidic inhibitor of HIV reverse transcription, became available in 2001. It has been extensively used worldwide and is now the most prescribed antiretroviral (ARV) drug. Its high antiviral activity and favorable metabolic profile are responsible for its success. Furthermore, TDF has been associated with other ARVs to form new combined antiretroviral treatments in only one tablet once-a-day, which increases treatment adherence. Fears of potential nephrotoxicity that tenofovir would have in common with two other drugs from the same family (adefovir, used to treat hepatitis B, and cidofovir, used to treat cytomegalovirus infections) were alleviated by the early clinical trials. Yet, in 2001, the first case of TDF-induced acute nephrotoxicity was published. Numerous cases have been published since then, and it is now established that TDF presents a tubular toxicity risk. Some facilitating factors have been identified, such as co-prescription of didanosine or boosted protease inhibitor, preexisting CKD, low body weight, and associated diabetes mellitus. Conversely, whether TDF is nephrotoxic in the long term is a highly debated question. Some studies suggest a decreased GFR when TDF is prescribed for a long period, while others indicate that TDF is safe for the kidneys even after many years of use. Here we review the differences in patient characteristics, study designs, and measured outcomes that can possibly explain these conflicting findings. We conclude with rational recommendation for appropriate TDF prescription.Keywords
This publication has 85 references indexed in Scilit:
- Prevalence and Risk Factors Associated to Chronic Kidney Disease in HIV-Infected Patients on HAART and Undetectable Viral Load in BrazilPLOS ONE, 2011
- Impact of Small Body Weight on Tenofovir-Associated Renal Dysfunction in HIV-Infected Patients: A Retrospective Cohort Study of Japanese PatientsPLOS ONE, 2011
- Vitamin D in HIV-Infected PatientsCurrent HIV/AIDS Reports, 2011
- Tenofovir renal proximal tubular toxicity is regulated By OAT1 and MRP4 transportersLaboratory Investigation, 2011
- Short Communication: Inadequate Vitamin D Exacerbates Parathyroid Hormone Elevations in Tenofovir UsersAIDS Research and Human Retroviruses, 2010
- Whole body bone scintigraphy in tenofovir-related osteomalacia: a case reportJournal of Medical Case Reports, 2009
- Acute renal failure in an AIDS patient on tenofovir: a case reportJournal of Medical Case Reports, 2008
- In Vitro Cytotoxicity and Mitochondrial Toxicity of Tenofovir Alone and in Combination with Other Antiretrovirals in Human Renal Proximal Tubule CellsAntimicrobial Agents and Chemotherapy, 2006
- Acquired Fanconi's Syndrome Associated with Tenofovir TherapyJournal of General Internal Medicine, 2006
- Mechanism of Active Renal Tubular Efflux of TenofovirAntimicrobial Agents and Chemotherapy, 2006