title: Tenofovir-induced Fanconi syndrome in chronic hepatitis B monoinfected patients that reverted after tenofovir withdrawal.
abstract: Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor widely used to treat patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. Despite the excellent safety records of this regimen, a few cases of acute renal failure and Fanconi syndrome have been reported among HIV patients exposed to TDF. In the HBV monoinfection scenario, only two cases of TDF-associated Fanconi syndrome have been reported thus far. Here, we describe two additional patients with chronic hepatitis B (CHB) who developed a TDF-induced Fanconi syndrome that reverted after TDF withdrawal and had viral replication fully suppressed upon switching to entecavir (ETV). Though the overall risk of TDF associated severe renal toxicity in HBV patients appears to be negligible, both glomerular and tubular function should be monitored in patients exposed to TDF, especially when other renal risk factors or a history of previous exposure to adefovir dipivoxil (ADV) are present.
authors.affiliation: Liver Unit, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Viganò
authors.affiliation: Medicine Unit, Ospedale Maggiore di Lodi, Lodi, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Brocchieri
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Angiola
authors.initials: A
authors.lastname: Spinetti
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Zaltron
authors.affiliation: "A. M. and A. Migliavacca" Center for Liver Disease, I Gastroenterology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Mangia
authors.affiliation: "A. M. and A. Migliavacca" Center for Liver Disease, I Gastroenterology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Facchetti
authors.affiliation: Medicine Unit, Ospedale Maggiore di Lodi, Lodi, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fugazza
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.affiliation: "A. M. and A. Migliavacca" Center for Liver Disease, I Gastroenterology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
authors.affiliation: "A. M. and A. Migliavacca" Center for Liver Disease, I Gastroenterology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. Electronic address: pietro.lampertico@unimi.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005198:Fanconi Syndrome / Q000139:chemically induced*; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D000068698:Tenofovir; D016896:Treatment Outcome; D019562:Viral Load; D028761:Withholding Treatment
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine
keywords: Adverse drug reaction; Entecavir; Fanconi syndrome; Hepatitis B virus; Tenofovir