Tenofovir alafenamide nephrotoxicity in an HIV-positive patient: A case report

Medicine (Baltimore). 2017 Sep;96(36):e8046. doi: 10.1097/MD.0000000000008046.

Abstract

Rationale: Tenofovir alafenamide (TAF) is novel prodrug of Tenofovir, a nucleotide reverse transcriptase inhibitor. TAF is less nephrotoxic than its predecessor prodrug, tenofovir disoproxil fumarate (TDF). Tenofovir causes mitochondrial dysfunction and tubular injury when there is elevated accumulation in proximal tubule cells. TAF's unique pharmacokinetic profile enables provision of lower required doses for antiviral efficacy. Lower concentrations reach renal tubules minimizing intracellular accumulation and mitochondrial damage. TAF has not been associated with the histologic markers of tenofovir-associated nephrotoxicity that are seen with TDF, such as dysmorphic mitochondria in proximal tubule cells. Here, we report a patient with dysmorphic mitochondria on kidney biopsy after initiating therapy with TAF.

Lessons: This case suggests that at risk individuals may experience tubular mitochondrial injury from lower concentrations of tenofovir with TAF.

Publication types

  • Case Reports

MeSH terms

  • Adenine / analogs & derivatives*
  • Adenine / therapeutic use
  • Adenine / toxicity
  • Alanine
  • Anti-HIV Agents / therapeutic use
  • Anti-HIV Agents / toxicity*
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / metabolism
  • HIV Infections / pathology
  • Humans
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / pathology
  • Kidney Diseases / therapy
  • Male
  • Middle Aged
  • Mitochondria / drug effects
  • Mitochondria / pathology
  • Prodrugs / therapeutic use
  • Prodrugs / toxicity*
  • Tenofovir / analogs & derivatives

Substances

  • Anti-HIV Agents
  • Prodrugs
  • Tenofovir
  • tenofovir alafenamide
  • Adenine
  • Alanine