Incidence of proximal renal tubular dysfunction in patients on tenofovir disoproxil fumarate.

摘要

Tenofovir disoproxil fumarate (TDF) is generally considered a safe drug, well tolerated by patients and is now recommended as a first-line agent in the backbone of triple agent combination therapy (ART). Since its approval in October 2001 however, there has been a link established between its use and the incidence of proximal renal tubular dysfunction (PRTD) and Fanconi syndrome (Type 2 proximal renal tubular acidosis).1 Some patients seem to be more vulnerable than others to adverse renal effects such as diabetics, those with hypertensive nephropathy and those also on ritonavir boosted protease inhibitors (PI/r).2 There are no British HIV Association (BHIVA) guidelines on how best to monitor or manage this problem, although the HIV Medical Association (HIVMA) have given an overview on the investigation types and how often screening for this problem should be performed in patients treated with TDF (namely by biannual monitoring of renal function, serum phosphorous and urine analysis for pro-teinuria and glycosuria);3 however, specific advice on when to consider withdrawal of the drug still lacks.