title: The case of chronic hepatitis B treatment with tenofovir: an update for nephrologists.
abstract: Tenofovir is a nucleotide acting both as an inhibitor of human immunodeficiency (HIV) reverse transcriptase and as a competitor for hepatitis B virus (HBV) RNA-directed DNA polymerase. Approved worldwide in 2001, tenofovir is used as a component of highly active antiretroviral therapy (HAART) in patients with HIV infection. Since 2008, it has also been indicated for treatment of chronic HBV infection or HIV/HBV co-infection. The aim of the treatment consists in suppressing viral replication, thus reducing hepatic complications and improving patient survival. Furthermore, tenofovir could represent an effective therapeutic option in lamivudine-resistant HBV patients. Tenofovir is eliminated unchanged through urine via glomerular filtration (80%) and proximal tubular secretion (20%). Thus, alterations in renal clearance may interfere with tenofovir pharmacokinetics and systemic drug concentrations, modifying the therapeutic response. Hence, a renal overload of tenofovir in patients with a pre-existing kidney impairment could result in a worsening of renal function. Following a brief introduction on HBV infection and its therapeutic options, we review the latest evidence, to our knowledge, on renal toxicity of tenofovir in HBV patients and on drug management.
authors.affiliation: Department of Medical and Surgical Sciences, Unit of Nephrology and Dialysis, University-Hospital "Magna Graecia", Via Michele Torcia, 4, 88100, Catanzaro, Italy, pepcop77@hotmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coppolino
authors.forename: Mariadelina
authors.initials: M
authors.lastname: Simeoni
authors.forename: Chiara
authors.initials: C
authors.lastname: Summaria
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Postorino
authors.forename: Laura
authors.initials: L
authors.lastname: Rivoli
authors.forename: Alessio
authors.initials: A
authors.lastname: Strazzulla
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fuiano
mesh_terms: D000998:Antiviral Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006515:Hepatitis B virus / Q000187:drug effects* / Q000254:growth & development; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D061214:Patient Safety; D065667:Renal Elimination; D018570:Risk Assessment; D000068698:Tenofovir / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D000068698:Tenofovir