The development of hypophosphataemic osteomalacia with myopathy in two patients with HIV infection receiving tenofovir therapy.
We report two cases in which osteomalacia developed in patients on tenofovir-containing highly active antiretroviral therapy (HAART) in the context of Fanconi syndrome with hypophosphataemia. Bone pain was the presenting feature and myopathy followed in one case. Disability was reversed with withdrawal of the drug and with mineral supplementation. The cases highlight the importance of considering the diagnosis of osteomalacia in patients treated with tenofovir. A possible association with incipient acute renal failure, particularly during nonsteroidal anti-inflammatory drug (NSAID) use, needs further investigation.
Parsonage
M J
MJ
Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Crumpsall, Manchester, UK.
Wilkins
E G L
EG
Snowden
N
N
Issa
B G
BG
Savage
M W
MW
D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005198:Fanconi Syndrome / Q000139:chemically induced; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D017674:Hypophosphatemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000139:chemically induced; D063065:Organophosphonates / Q000009:adverse effects*; D010018:Osteomalacia / Q000139:chemically induced*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D000068698:Tenofovir
D019380:Anti-HIV Agents; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D000225:Adenine