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Updated: Dec 8, 2025

Quantitative Structure-Activity Relationship, Activity Prediction, and Molecular Dynamics of Non-nucleotide Reverse Transcriptase Inhibitors
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Tenofovir-induced delayed nephro-osteo toxicity.

Bhargavi Kumar1, Rajgokul Prabhakar1, Saravanan Thangavelu2

  • 1Department of Medicine, PSG, IMS<R, Coimbatore, Tamil Nadu, India.

The Journal of the Royal College of Physicians of Edinburgh
|September 16, 2020
PubMed
Summary

Tenofovir disoproxil fumarate (TDF), a key HIV-1 medication, can cause kidney damage and bone issues. This case highlights a patient developing Fanconi syndrome and a femur fracture after long-term TDF use.

Keywords:
Fanconi syndromeosteomalaciaproximal renal tubuletenofovir

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Area of Science:

  • * Pharmacology and Toxicology
  • * Nephrology and Endocrinology

Background:

  • * Tenofovir disoproxil fumarate (TDF) is a primary nucleotide reverse-transcriptase inhibitor for treatment-naive HIV-1 patients over 10 years old and weighing over 30 kg.
  • * While generally safe, TDF is associated with nephrotoxicity (1-6% incidence) and potential osteomalacia due to hypophosphatemia.

Observation:

  • * A 50-year-old HIV-positive male patient was on TDF therapy.
  • * The patient presented with proximal renal tubular acidosis and a left femoral neck fracture.

Findings:

  • * The patient's renal and bone complications occurred four years after initiating TDF treatment.
  • * Proximal renal tubular acidosis indicates dysfunction of the kidney's tubules, potentially linked to TDF exposure.
  • * The femoral neck fracture suggests underlying osteomalacia secondary to TDF-induced metabolic disturbances.

Implications:

  • * Highlights the importance of long-term monitoring for renal and bone toxicity in patients on TDF.
  • * Suggests a need for early detection and management of TDF-related nephrotoxicity and hypophosphatemia.
  • * Informs clinical practice regarding the comprehensive assessment of patients experiencing fractures or renal dysfunction during TDF therapy.