Fanconi Syndrome Induced by Concomitant HIV PrEP and Tacrolimus

Abstract

Fanconi syndrome (FS) is a severe grade of drug-induced proximal tubule toxicity. There are numerous causes for acquired FS, and drug toxicity is one of the most common. FS is known to be associated with the nucleoside reverse transcriptase inhibitor (NRTI) tenofovir disoproxil fumarate (TDF). TDF is often used in combination with emtricitabine (FTC) for preexposure prophylaxis (PrEP) of human immunodeficiency virus (HIV) infection. TDF/FTC-induced FS has been observed as a dose-related phenomenon that is directly correlated to kidney function, high levels of absorption of the drug into the proximal tubule, and interactions with other medications. This case report describes a patient who acquired FS after starting TDF/FTC for PrEP in the setting of chronic kidney disease (CKD) with concomitant tacrolimus therapy, a known nephrotoxic agent.

Fanconi Syndrome in Patients With Human Immunodeficiency Virus Treated With Tenofovir-Based Antiretroviral Therapy: A Systematic Literature Review

“…Our review focused specifically on patients with HIV diagnosed with FS while on tenofovir, and may not be generalizable to other patient populations. Although outside the scope of this review, there have been reports of FS in patients taking tenofovir for treatment of hepatitis B, [87][88][89][90][91] HIV PrEP [92][93][94] and PEP. 95 Characterizing the risk of FS in these populations is also important given the extensive use of tenofovir for these indications.…”