Tenofovir‐Related Nephrotoxicity: Case Report and Review of the Literature

James, Christopher W.; Steinhaus, Mary C.; Szabo, Susan; Dressler, Robert

doi:10.1592/phco.24.4.415.33182

Cited by 85 publications

(52 citation statements)

References 7 publications

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“…Our study shows statistical association between ARV drugs and CKD that needs to be documented further to identify nephrotoxic mechanisms. Tenofovir and indinavir have been shown to be related to nephrotoxicity in many studies (2,5,6,10,11,25). Some factors (hepatitis B or C and diabetes) traditionally reported as related to CKD in persons with or without HIV-1 infection were not found to be independently associated with the occurrence of CKD in our analysis (5,26,27).…”

Section: Discussionmentioning

confidence: 48%

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Flandre¹,

Puglièse²,

Cuzin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients.Design, setting, participants, & measurements Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR Յ60 ml/min per 1.73 m 2 over Ն3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD.Results From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naïve. Occurrence of acute kidney injury (hazard ratio [HR] ϭ 2.40) and hypertension (HR ϭ 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count Ͼ200 cells/mm 3 had a lower risk of CKD (HR ϭ 0.63). Recent exposure to indinavir (HR ϭ 2.03), totenofovir (HR ϭ 1.55), and abacavir (HR ϭ 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR ϭ 2.23), and a trend toward significance was observed for past exposure to indinavir (HR ϭ 1.28).Conclusions CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.

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Section: Discussionmentioning

confidence: 48%

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Flandre¹,

Puglièse²,

Cuzin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Rare cases of acute renal failure and Fanconi syndrome (dysfunction of renal tubules resulting in excessive renal loss of glucose, amino acids, and electrolytes) have been described in association with TDF exposure. [30][31][32][33] The cumulative incidence of nephrotoxicity in TDF-containing regimens has been reported between 1% and 4%, with the rate of Fanconi syndrome between 0.5% to 2.0%. 34 Nephrotoxicity most frequently occurs in patients with prior underlying renal abnormalities or those concomitantly exposed to other nephrotoxic agents.…”

Section: Pharmacokinetics and Toxicity Of Tdfmentioning

confidence: 99%

Neuropsychiatric effects of tenofovir in comparison with other antiretroviral drugs

Ferrer¹,

Rakhmanina²

2013

NBHIV

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Abstract:Tenofovir is a widely used antiretroviral medication indicated to treat adults and children infected with HIV. Current guidelines for the management of HIV infection recommend tenofovir disoproxil fumarate (TDF) as a component of the preferred first-line combination antiretroviral therapy. The efficacy, tolerability, prolonged half-life allowing for once-daily administration, and availability as a component of several fixed-dose formulations make TDF an attractive choice for treatment-naive and treatment-experienced HIV-infected patients. TDF is also widely used as a component of postexposure prophylaxis in noninfected individuals. Most importantly, it has been recently approved for use as pre-exposure prophylaxis for noninfected adults and adolescents to reduce the risk of HIV transmission. With increasing use of TDF among adults and children, understanding of the potential for drug-associated side effects is important. This review focuses on the neuropsychiatric effects of tenofovir in adults and children with HIV infection in comparison with other antiretroviral drugs.

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“…A number of cofactors, such as African-American ethnicity, advanced immunodeficiency (CD4 cell count o200 cells/mL), detectable HIV plasma viral load (pVL)44000 copies/mL, hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection, high blood pressure (HBP) and diabetes mellitus (DM), have all been associated with nephropathy in HIV-infected subjects [14][15][16]. Highly active antiretroviral therapy (HAART) seems to improve the overall survival rate of patients with HIVAN and reduce the incidence of cases of HIV-related kidney damage [17,18], but some specific antiretroviral (ARV) drugs, such as indinavir [19,20] and tenofovir (TDF) [20][21][22][23][24][25][26][27][28][29][30], have been associated with increased risk of acute and chronic renal failure. HIV-infected patients may also be frequently exposed to nephrotoxic drugs, commonly used for treatment or prophylaxis of opportunistic infections, and this practice may result in overlapping renal toxicity between these agents and ARVs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of glomerular filtration rate estimates vs. 24‐h creatinine clearance in HIV‐positive patients

Ravasi¹,

Lauriola²,

Tinelli

et al. 2009

HIV Medicine

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BackgroundGuidelines for kidney function monitoring and antiretroviral drug dosing are available and respectively refer to glomerular filtration rate and creatinine clearance (CrCl). ObjectiveThe aim of the study was to compare kidney function estimates vs. measured 24-h CrCl in HIVinfected subjects. MethodsA cross-sectional design was used, with comparison of Cockcroft-Gault (CG), original and simplified modification of diet in renal disease (MDRD) equations vs. measured 24-h CrCl. Subjects were HIVinfected, 18-70 years old, without pre-existing kidney disease. ResultsResults are presented as mean (AE standard deviation), unless otherwise stated. The study population consisted of 90 patients, of whom 71% were male, with a mean age of 45 years (AE 6.5 years). At the time of evaluation, the mean body mass index was 23 (AE 3.3); mean serum creatinine was 0.91 mg/dL (AE 0.2 mg/dL); and mean blood urea nitrogen (BUN) was 34.7 mg/dL (AE 10.6 mg/dL). Differences between paired methods were all significant (Po0.00001), except between CG and simplified MDRD (P 5 0.21; Pearson r 5 0.81). In univariate analysis, male gender, CD4 nadir, hepatitis B virus coinfection, BUN and current CD4 cell count showed a significant positive correlation (Po0.2) with the difference between measured 24-h CrCl and either CG or simplified MDRD estimates. In multivariate analysis, only BUN showed a significant positive correlation (Po0.05). ConclusionsEstimates were lower than the measurements of 24-h CrCl. Original MDRD estimates were lower than those with other equations. CG and simplified MDRD estimates showed a satisfactory correlation.

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Tenofovir‐Related Nephrotoxicity: Case Report and Review of the Literature

Cited by 85 publications

References 7 publications

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Risk Factors of Chronic Kidney Disease in HIV-infected Patients

Neuropsychiatric effects of tenofovir in comparison with other antiretroviral drugs

Comparison of glomerular filtration rate estimates vs. 24‐h creatinine clearance in HIV‐positive patients

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