title: Renal and Bone Adverse Effects of a Tenofovir-Based Regimen in the Treatment of HIV-Infected Children: A Systematic Review.
abstract: BACKGROUND
  Tenofovir disoproxil fumarate (TDF)-containing regimens in the treatment of HIV-infected children have safety concerns with respect to renal and bone toxicity.
  
  
  OBJECTIVE
  The aim of this study was to systematically review and critically appraise the literature relating to the reported renal and bone adverse effects of TDF-based regimens in the treatment of HIV-infected children from 2 to 19 years old.
  
  
  METHODS
  Searches were performed using the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, OvidSP, ScienceDirect and Web of Science databases and platforms. All primary studies involving tenofovir use in HIV-infected children were sought. Studies that involved the use of TDF for pre- and post-exposure prophylaxis, and treatment of chronic hepatitis B virus infection were excluded. Data on study characteristics, participant's characteristics, therapeutic intervention and adverse effects were extracted using a piloted tool. In addition, pharmacovigilance data from the WHO Adverse Reaction database were included.
  
  
  RESULTS
  We identified 19 studies that reported the presence of renal and bone adverse effects of TDF and these included a total of 1100 study participants. The reports were in distinctly heterogeneous participant groups. A total of 287 renal and bone adverse effects were reported (250 renal and 37 bone adverse effects). Approximately 238 (21.6 %) participants were affected by these adverse effects. Of these, 15 participants stopped their TDF-containing regimen due to these adverse effects. In addition, the pharmacovigilance data from the WHO Adverse Reaction database reported 101 renal and bone adverse effects for patients whose indication was HIV/AIDS.
  
  
  CONCLUSIONS
  This systematic review summarises the reports of renal and bone adverse effects of a TDF-containing regimen in the treatment of HIV-infected children. Our findings suggest that the benefits of using TDF in children need to be balanced against the potential risk of toxicity.
authors.affiliation: Department of Child Health, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Edo State, Nigeria. roseezimuo@yahoo.com.
authors.forename: Rose I
authors.initials: RI
authors.lastname: Okonkwo
authors.affiliation: School of Pharmacy, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Weidmann
authors.affiliation: Internal Medicine, Faculty of Medicine and Dentistry, University of Calabar, Calabar, Cross River State, Nigeria.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Effa
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D001847:Bone Diseases / Q000139:chemically induced* / Q000453:epidemiology; D002648:Child; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D000068698:Tenofovir / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir