Severe Acute Renal Failure in an HIV-Infected Patient After Only 2 Weeks of Tenofovir-Based Antiretroviral Therapy

Abstract

We report a 46-year-old man who has sex with men (MSM) patient, of Scottish descent, who had no history of arterial hypertension, diabetes, or illicit drug use, was hepatitis C virus (HCV) negative but underwent right nephrectomy for urothelial tumor in 2006. Before starting antiretroviral therapy, he had a CD4 cell count of 316/mm(3) and plasma HIV RNA level was 1,020,537 copies per milliliter. He developed acute renal failure only 2 weeks after introduction of tenofovir-based antiretroviral therapy and then required 3 months of hemodialysis. After the end of hemodialysis, antiviral therapy was resumed with abacavir (300 mg×2/day), lamivudine (300 mg every day), and lopinavir/ritonavir (400/100 mg twice daily). Renal biopsy revealed severe and diffuse toxic acute tubular necrosis Two years after tenofovir discontinuation, the patient's renal function remained subnormal. Although severe renal toxicity due to tenofovir is rare, patients receiving tenofovir must be monitored closely for renal dysfunction especially during the first weeks of tenofovir therapy.

Safety profile of antiviral medications: A pharmacovigilance study using the Italian spontaneous-reporting database

“…While antivirals have been rarely associated with acute renal failure, there are few published populationbased studies on this issue. [46][47][48] As reported with indinavir, acyclovir could precipitate in nephrons, thus leading to kidney injury. 1 The signals our data indicate with regard to antiviral use and asthenia and fever are not clearly supported by a pharmacologic rationale, and we suspect that those symptoms were byproducts of other ADRs or attributable to underlying diseases.…”

Analisis Kadar Kreatinin Serum Sebelum dan Setelah Terapi Tenovofir pada Penyandang HIV di RS Dr. M. Djamil Padang Periode 2012-2013

“…HIV dengan terapi tenofovir. 5,6 Tenofovir dapat menyebabkan gagal ginjal akut setelah dua minggu pemakaian. 6,7 Kadar kreatinin serum meningkat dari 0,8 mg/dL menjadi 2,6 mg/dL setelah dua minggu terapi.…”

Patient-Reported Symptoms on the Antiretroviral Regimen Efavirenz/Emtricitabine/Tenofovir

“…There may be asymptomatic side effects and toxicities, such as renal disease and bone mineral density loss, known to be associated with tenofovir, which this study was not designed to capture. [24][25][26]57 Finally, as we conducted a cross-sectional analysis, we are unable to determine whether the medications were causing the different symptom profiles or if there were underlying differences in the symptom experiences of the patients at baseline, which may have impacted prescribing decisions. However, that the associations between cART regimen and symptoms remained largely unchanged even after adjusting for disease severity and treatment characteristics, suggests that the relationship is, in fact, related to differences in cART regimens and not underlying characteristics of the clinical population.…”

“…Eighty to ninety percent of patients newly diagnosed with HIV in the United States are now started on a once a day combination of EFV/FTC/TDF (also known as AtriplaÒ, Bristol-Myers Squibb, Princeton, NJ and Gilead Sciences, LLC., Foster City, CA), 23 although it is teratogenic and associated with renal disease and osteoporotic bone fractures. 20,[24][25][26][27] Despite its wide use and support, studies assessing tolerability of EFV/FTC/TDF are limited in their applicability to the general HIV-infected population. For example, study samples are younger with less advanced HIV disease and fewer comorbid illnesses.…”