Reynes J, Peyriere H, Merle de Boever C, Moing VL; Conference on Retroviruses and Opportunistic Infections.

Abstr 10th Conf Retrovir Oppor Infect Feb 10 14 2003 Hynes Conv Cent Boston Mass USA Conf Retrovir Oppor Infect 10th 2003 Boston Mass. 2003 Feb 10-14; 10: abstract no. 717.

CHU Montpellier, France

BACKGROUND: Tenofovir (TDF) is close to adefovir and cidofovir, 2 other nucleotide analogues that have been previously involved in renal tubular dysfunction. In short-term clinical trials, TDF did not exhibit more frequent nephrotoxicity compared to placebo. We observed 3 cases of HIV-infected patients (pts) who presented Fanconi syndrome while taking an antiretroviral regimen containing TDF.METHODS: Case study in a single HIV outpatient clinics.RESULTS: Eighty-one (81) antiretroviral-experienced pts started a TDF-containing antiretroviral regimen between March 2001 and March 2002, among whom 74 had more than 6 months of cumulative TDF exposition as of October 2002. Among these 74 pts, 3 (2 women and 1 man) developed renal tubular injury, with hypophosphoremia (0.39; 0.47; 0.41 mM/l for pt 1, 2, and 3, respectively), glycosuria (105; 7.7; and 0.8 g/l for pt 1, 2, and 3, respectively), proteinuria (1.22; 1.6; 1.15 g/l for pt 1, 2, and 3, respectively), and a decrease in creatinine clearance (of 32, 47, and 20% for pt 1, 2, and 3, respectively). The first biological signs of tubular injury appeared after a duration of TDF therapy of 8, 11, and 9 months for pt 1, 2, and 3, respectively, and resolved within less than 3 months after TDF was stopped. Two pts (ndegrees1 and 2) had myalgias and/or paresthesias possibly related to hypophosphoremia which resolved within 1 wk after interruption of TDF. All pts had a low weight (< 60 kgs), none had diabetes or hyperlactatemia. All pts received low doses of ritonavir and 1 pt received didanosine (patient ndegrees3). However, in 2 pts (ndegrees1 and ndegrees3), only TDF was stopped and the signs resolved.CONCLUSIONS: Long-term TDF therapy may be associated with Fanconi syndrome which is related to injury of proximal tubular cells in the nephron and may lead to renal failure. Given the reversibility of this disorder, we recommend periodic screening for the pts on long-term TDF therapy, by measuring phosphoremia, glycosuria, proteinuria, and renal function.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Adenine
• Antiretroviral Therapy, Highly Active
• Fanconi Anemia
• Fanconi Syndrome
• Female
• Glycosuria
• HIV Infections
• Humans
• Kidney
• Kidney Diseases
• Kidney Failure
• Kidney Function Tests
• Male
• Phosphonic Acids
• Proteinuria
• Ureteral Diseases
• adefovir
• cidofovir
• drug therapy
• injuries
• tenofovir
• therapy

Other ID:

• GWAIDS0021732

UI: 102261356

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