Fatal lactic acidosis and acute renal failure after addition of tenofovir to an antiretroviral regimen containing didanosine.
We describe a 49-year-old man with human immunodeficiency virus infection and stable chronic renal insufficiency who developed acute oliguric renal failure and severe lactic acidosis and who died several weeks after tenofovir was added to an antiretroviral regimen that included didanosine. Although the role of tenofovir in precipitating acute renal failure is unclear, progressive accumulation of the drug and pharmacologic interaction that caused increased levels of didanosine were the likely antecedents of increased mitochondrial toxicity that led to lactic acidosis.
Murphy
Melissa D
MD
Infectious Disease Section, Veterans Affairs Medical Center, and Oregon Health and Science University, Portland, Oregon 97201, USA. melissa.murphy@med.va.gov
O'Hearn
Mary
M
Chou
Sunwen
S
D000140:Acidosis, Lactic / Q000139:chemically induced*; D058186:Acute Kidney Injury / Q000139:chemically induced*; D000225:Adenine / Q000009:adverse effects* / Q000031:analogs & derivatives*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active; D016049:Didanosine / Q000009:adverse effects*; D004357:Drug Synergism; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000187:drug effects; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000009:adverse effects*; D000068698:Tenofovir
D019380:Anti-HIV Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D000068698:Tenofovir; D000225:Adenine; D016049:Didanosine