Renal tubular dysfunction associated with tenofovir therapy

Area of Science:

• Nephrology
• Infectious Diseases
• Pharmacology

Background:

• Tenofovir (TDF) is a crucial antiretroviral therapy (ART) for people living with HIV/AIDS (PLHA).
• Nephrotoxicity is a known adverse effect of TDF, necessitating monitoring in PLHA.
• Understanding the incidence and characteristics of TDF-induced nephrotoxicity is vital for patient management.

Purpose of the Study:

• To determine the incidence and clinical characteristics of Tenofovir (TDF)-induced nephrotoxicity.
• To describe the renal dysfunction in people living with HIV/AIDS (PLHA) on TDF-based ART.
• To evaluate the reversibility of TDF-associated renal dysfunction.

Main Methods:

• A retrospective medical record review was conducted.
• The study included PLHA receiving TDF-based ART at Christian Medical College, Vellore.
• Data collected included patient demographics, ART regimens, and laboratory parameters.

Main Results:

• 10 out of 274 (3.6%) PLHA developed TDF-induced renal dysfunction after a mean of 42.6 months.
• Patients exhibited proteinuria, decreased creatinine clearance, hypophosphatemia, and elevated alkaline phosphatase.
• Seven patients presented with Fanconi syndrome; all improved after TDF discontinuation and supplementation.

Conclusions:

• TDF-associated renal dysfunction has a prolonged, often asymptomatic, incubation period.
• Laboratory monitoring (creatinine clearance, urine analysis, phosphate levels) is essential for early diagnosis.
• Discontinuation of TDF and supportive care lead to reversible tubular dysfunction.