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Renal tubular dysfunction seen with tenofovir HIV therapy
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NEW YORK (Reuters Health) - HIV therapy with the nucleotide analogue tenofovir (Viread) may lead to renal tubular dysfunction, particularly in patients with low body weight, according to French researchers.
Dr. Helene Peyriere of Lapeyronie Hospital in Montpellier and colleagues report on seven such cases in the March 1st issue of the Journal of Acquired Immune Deficiency Syndromes.
The patients, 2 men and 5 women, showed signs of renal toxicity from 5 weeks to 16 months after starting tenofovir treatment.
Laboratory abnormalities rapidly improved within 4 months of stopping tenofovir alone or stopping tenofovir and other antiretrovirals. The researchers point out that "it seems unlikely that other drugs were responsible for renal dysfunction, because in 5 patients only the tenofovir was discontinued."
Nevertheless, all patients had previously been extensively treated with nucleoside reverse transcriptase inhibitors and the investigators speculate that after several months of therapy "tenofovir could worsen latent tubular injury in patients with a mitochondrial defect" caused by such earlier treatment.
Another common feature was that 6 of the patients had a body weight below 60 kg and some showed a decrease in creatinine clearance at baseline.
The researchers thus conclude that in such patients, "intensive renal monitoring, including creatinine clearance, proteinuria and glycosuria, is essential at baseline and during treatment with tenofovir."
J Acquir Immune Defic Syndr 2004;163:269-273
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