title: [Renal toxicity in HIV-infected patients receiving HAART including tenofovir].
abstract: HIV-infected patients may undergo renal damage related to the HIV infection itself, to the presence of co-infections, arterial hypertension, diabetes or to the exposure to nephrotoxic drugs. Tenofovir has been associated with the development of acute renal failure with Fanconi syndrome and acute tubular necrosis and, albeit rarely, with chronic liver disease. Patients with low CD4 cell count, low body weight and with concomitant diseases such as arterial hypertension and diabetes or co-infections with HCV, HBV or Treponema pallidum seem at higher risk of tenofovir-related nephrotoxicity. Other risk factors include previous exposure to nephrotoxic drugs and the association of tenofovir with boosted protease inhibitors or with didanosine. However, from the analysis of published papers the incidence of tenofovir-related renal toxicity seems low, as confirmed also by our personal casuistry (SCOLTA Project). Thus, a careful selection of patients including the evaluation of existent renal disease before starting an antiretroviral regimen including tenofovir is necessary to prevent renal damage. Furthermore, frequent monitoring of renal function in patients at higher risk of renal damage is strongly recommended, as well as a tenofovir dose adjustment if an alteration of renal function is detected.
authors.affiliation: Istituto di Malattie Infettive, Ospedale di Sassari, Italy.
authors.forename: Giordano
authors.initials: G
authors.lastname: Madeddu
authors.forename: Tiziana
authors.initials: T
authors.lastname: Quirino
authors.forename: Silvia
authors.initials: S
authors.lastname: Carradori
authors.forename: Elena
authors.initials: E
authors.lastname: Ricci
authors.forename: Carmela
authors.initials: C
authors.lastname: Grosso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Penco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Socio
authors.forename: Elena
authors.initials: E
authors.lastname: Rossella
authors.forename: Loredana
authors.initials: L
authors.lastname: Palvarini
authors.forename: Patrizia
authors.initials: P
authors.lastname: Marconi
authors.forename: Sara
authors.initials: S
authors.lastname: Melzi
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Mura
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonfanti
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D004347:Drug Interactions; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D063065:Organophosphonates / Q000009:adverse effects*; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine