title: Is Tenofovir Alafenamide Safer than Tenofovir Disoproxil Fumarate for the Kidneys?
abstract: Tenofovir disoproxil fumarate is currently the cornerstone of HIV treatment. Although it shows an overall good safety profile, numerous cases of nephrotoxicity have been reported. Tenofovir alafenamide is a novel tenofovir prodrug that has been developed to improve renal safety. Pharmacokinetic studies suggest a better renal tolerance of tenofovir alafenamide than tenofovir disoproxil fumarate, probably because tenofovir plasma concentrations are lower after tenofovir alafenamide administration. Consistently in clinical trials, renal tolerance seems to be improved in patients treated with tenofovir alafenamide. However, some questions remain. First, whether tenofovir can accumulate and lead to nephrotoxicity under specific circumstances after tenofovir alafenamide administration is unknown. Second, only "real-world practice" will inform us on the long-term renal safety of tenofovir alafenamide. Last, tenofovir alafenamide renal safety in patients with chronic kidney disease has not been studied in any randomized clinical trial. In conclusion, tenofovir alafenamide appears as a very promising drug and long-term safety will be an important determinant of its expanded use.
authors.affiliation: AP-HP, Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|Service ICAR, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Aloy
authors.affiliation: AP-HP, Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|University Pierre et Marie Curie, Paris, France.
authors.forename: Imane
authors.initials: I
authors.lastname: Tazi
authors.affiliation: AP-HP, Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|University Pierre et Marie Curie, Paris, France.
authors.forename: Corinne Isnard
authors.initials: CI
authors.lastname: Bagnis
authors.affiliation: AP-HP, Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|University Pierre et Marie Curie, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Gauthier
authors.affiliation: AP-HP, Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|Service ICAR, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Janus
authors.affiliation: AP-HP, Service de néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|Service ICAR, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Launay-Vacher
authors.affiliation: AP-HP, Service de néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|Service ICAR, Hôpital Pitié-Salpêtrière, Paris, France.|University Pierre et Marie Curie, Paris, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Deray
authors.affiliation: AP-HP, Service de néphrologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.|University Pierre et Marie Curie, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Tourret
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics; D000409:Alanine; D019380:Anti-HIV Agents / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000150:complications; D000068698:Tenofovir / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics / Q000031:analogs & derivatives
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir; C442442:tenofovir alafenamide; D000225:Adenine; D000409:Alanine