title: Tenofovir induced Fanconi syndrome: a possible pharmacokinetic interaction.
abstract: Tenofovir was introduced as a second line drug for the treatment of human immunodeficiency virus (HIV) infection in India in December 2009. Although rare, renal toxicity is a recognized adverse drug reaction (ADR) of this drug, especially when administered with boosted lopinavir-ritonavir. In this case, an HIV positive patient receiving tenofovir based antiretroviral therapy (ART) for last 1 year developed albuminuria, glycosuria and hypophosphatemia. Renal function tests and random blood sugar were within normal limits. He was diagnosed as a case of tenofovir induced Fanconi syndrome. Tenofovir was discontinued and patient was prescribed an alternate regimen. Five months later clinical symptoms and renal functions returned to normal. A pharmacokinetic interaction between tenofovir and ritonavir may have resulted in the toxicity. A periodic monitoring of renal functions is desirable in patients on tenofovir based ART.
authors.affiliation: Department of Pharmacology, B. J. Medical College, Ahmedabad, India.
authors.forename: Jigar
authors.initials: J
authors.lastname: Kapadia
authors.forename: Samidh
authors.initials: S
authors.lastname: Shah
authors.forename: Chetna
authors.initials: C
authors.lastname: Desai
authors.forename: Mira
authors.initials: M
authors.lastname: Desai
authors.forename: Shivani
authors.initials: S
authors.lastname: Patel
authors.forename: Asha N
authors.initials: AN
authors.lastname: Shah
authors.forename: R K
authors.initials: RK
authors.lastname: Dikshit
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000419:Albuminuria / Q000139:chemically induced / Q000175:diagnosis; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D006029:Glycosuria / Q000139:chemically induced / Q000175:diagnosis; D015658:HIV Infections / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D017674:Hypophosphatemia / Q000139:chemically induced / Q000175:diagnosis; D007194:India; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects* / Q000493:pharmacokinetics; D019438:Ritonavir / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000068698:Tenofovir; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine; D019438:Ritonavir
keywords: Adverse drug reaction; Fanconi syndrome; protease inhibitor; tenofovir