Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence

Am J Kidney Dis. 2011 May;57(5):773-80. doi: 10.1053/j.ajkd.2011.01.022. Epub 2011 Mar 23.


Tenofovir (TDF) is an effective and widely used treatment for both human immunodeficiency virus (HIV) and hepatitis B virus infection. Although studies suggest that TDF has a low overall toxicity profile and only a modest effect on estimated glomerular filtration rate, numerous case reports have since appeared in the literature describing TDF-associated renal tubular dysfunction, and this is now a significant source of HIV-related referrals to nephrologists. The main target of toxicity appears to be the proximal tubule, and in severe cases, patients can develop renal Fanconi syndrome. We review findings from recent studies in this area performed by ourselves and others and discuss our direct experience as practicing nephrologists. In particular, we discuss: (1) the nature and extent of TDF-associated kidney toxicity in the HIV-infected population, (2) potential underlying mechanisms of toxicity in the proximal tubule, (3) risk factors for developing tubular dysfunction, and (4) suggested strategies to monitor patients on TDF therapy.

Publication types

  • Review

MeSH terms

  • Adenine / adverse effects
  • Adenine / analogs & derivatives*
  • Animals
  • Fanconi Syndrome / chemically induced
  • Fanconi Syndrome / physiopathology
  • Glomerular Filtration Rate / drug effects
  • Glomerular Filtration Rate / physiology
  • HIV Infections* / complications
  • HIV Infections* / physiopathology
  • Humans
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / etiology
  • Kidney Diseases / physiopathology*
  • Kidney Tubules, Proximal / drug effects
  • Kidney Tubules, Proximal / physiopathology
  • Organophosphonates / adverse effects*
  • Risk Factors
  • Tenofovir


  • Organophosphonates
  • Tenofovir
  • Adenine