Tenofovir alafenamide/tenofovir disoproxil fumarate

Abstract

Acute tubular necrosis: case report A 56-year-old woman developed acute tubular necrosis following treatment with tenofovir alafenamide and tenofovir disoproxil fumarate for HIV infection [routes and dosages not stated; time to reaction onset not clearly stated]. The woman, who had HIV infection, had been receiving combined antiretroviral therapy (cART) with tenofovir disoproxil fumarate, emtricitabine and atazanavir/ritonavir from 2011. Her medical history was significant for diabetes, depressive syndrome, gastroesophageal reflux disease, dyslipidaemia and hypovitaminosis-D. In May 2018, laboratory investigation revealed rise in serum creatinine. The woman’s cART therapy was modified by switching tenofovir disoproxil fumarate to tenofovir alafenamide. Investigations revealed impaired renal function. After one month of tenofovir alafenamide therapy, further deterioration in renal parameters was noted. Therefore, cART therapy was again modified by switching atazanavir/ritonavir to dolutegravir. However, further worsening of renal function was observed. She was hospitalised. She was treated with insulin for uncontrolled diabetes. An echo-scan demonstrated normal-sized kidneys with moderately hyperechoic cortical as for initial nephropathy. A renal needle biopsy was performed and histological examination revealed acute tubular necrosis associated with tubular and interstitial infiltrate. Her cART therapy was switched to raltegravir and etravirine leading to good tolerability and viro-immunological parameters. After 1 month, serum creatinine improved. In October 2018, renal function was noted to be stable. Upon follow-up laboratory investigations in 2019 and 2020, renal parameters were noted to be stable. The acute tubular necrosis was considered to have developed secondary to tenofovir disoproxil fumarate due to accumulation of intracellular tenofovir. Subsequent switch to tenofovir alafenamide was suspected to have contributed in the acute tubular necrosis.