Tenofovir alafenamide nephrotoxicity: a case report and literature review

AIDS Research and Therapy

Thornthun Ueaphongsukkit¹  Jerasit Surintrspanont²  Kroonpong Iampenkhae²  Suwasin Udomkarnjananun³  Yingyos Avihingsanon³  Sivaporn Gatechompol⁴  Anchalee Avihingsanon⁴ 

[1] Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand;Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873, Rama 4 road, Pathumwan, 10330, Bangkok, Thailand;Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand;Renal Immunology and Transplant Research Unit, Chulalongkorn University, Bangkok, Thailand;The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand;Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

关键词: Tenofovir alafenamide;    Acute kidney injury;    Nephrotoxicity;    Renal pathology;    Mitochondria;    HIV;    Antiretroviral therapy;    Case report;   

DOI  :  10.1186/s12981-021-00380-w

来源: Springer

【 摘 要 】

BackgroundTenofovir alafenamide (TAF), a novel prodrug of tenofovir (TFV), has become the preferred drug for the treatment of HIV-1 and chronic hepatitis B infection in clinical practice. Results from clinical trials showed that it had better renal and bone mineral outcomes compared to tenofovir disoproxil fumarate (TDF). However, as we have seen with TDF, side effects from the new medication can be more prevalent and recognized after extensive use in real world situations. Sporadic cases of acute kidney injury in patients using TAF have started to emerge.Case presentationWe report a case of 49-year-old Thai, HIV treatment-experienced female with hypertension presented with worsening renal function after switching her antiretroviral regimen from TDF, emtricitabine (FTC), and lopinavir/ritonavir (LPV/r) to TAF, FTC and dolutegravir (DTG) for 3 months. Kidney biopsy showed distinctive picture of tenofovir nephrotoxicity with acute tubular injury and mitochondrial injury. The possible causes of acute kidney injury and nephrotoxicity from TAF for this patient were discussed. We have extensively reviewed all published case reports of TAF-associated nephrotoxicity and summarized the essential information in this article.ConclusionAlthough TAF has less nephrotoxicity compared with TDF; renal function should always be monitored after the initiation of both drugs. Future large cohort studies are required to identify the risk factors of TAF-associated nephrotoxicity and to design an effective preventive strategy.

【 授权许可】

CC BY