Tenofovir-induced Fanconi syndrome and osteomalacia in two HIV-infected patients: role of intracellular tenofovir diphosphate levels and review of the literature

Scand J Infect Dis. 2011 Oct;43(10):821-6. doi: 10.3109/00365548.2011.577805. Epub 2011 May 12.

Abstract

We present 2 human immunodeficiency virus-infected patients with tenofovir disoproxil fumarate-induced Fanconi syndrome, leading to osteomalacia. Intracellular tenofovir diphosphate levels were measured in 1 patient and were found to be very high, with plasma tenofovir levels just slightly elevated. Fibroblast growth factor-23, a phosphaturic hormone, was decreased in both patients and is therefore unlikely to have a pathophysiological role in this pathology. The different potential factors contributing to the development of tenofovir-related kidney proximal tubular dysfunction are discussed and the data presented may help to further elucidate its pathogenesis.

Publication types

  • Case Reports

MeSH terms

  • Adenine / adverse effects
  • Adenine / analogs & derivatives*
  • Adenine / blood
  • Adenine / therapeutic use
  • Adult
  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • Diphosphates / blood
  • Fanconi Syndrome / chemically induced*
  • Fanconi Syndrome / diagnosis
  • Fanconi Syndrome / diagnostic imaging
  • Fanconi Syndrome / virology
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Organophosphonates / adverse effects*
  • Organophosphonates / blood
  • Organophosphonates / therapeutic use
  • Osteomalacia / chemically induced*
  • Osteomalacia / diagnosis
  • Osteomalacia / virology
  • Radionuclide Imaging
  • Tenofovir
  • Whole Body Imaging

Substances

  • Anti-HIV Agents
  • Diphosphates
  • Organophosphonates
  • Tenofovir
  • Adenine