Tenofovir-induced osteomalacia

We present an HIV-infected woman in whom antiretroviral treatment with tenofovir disoproxil fumarate (TDF) induced severe skeletal pain, synovial effusions and multiple fractures secondary to a Fanconi syndrome with hypophosphatemia and osteomalacia. TDF interferes with the replication of mitochondr...

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Bibliographic Details
Published in:Clinical and experimental rheumatology 2009-11, Vol.27 (6), p.1001-1003
Main Authors: WANNER, D. P, TYNDALL, A, WALKER, U. A
Format: Article
Language:English
Subjects:
Adenine - adverse effects
Adenine - analogs & derivatives
Anti-HIV Agents - adverse effects
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiviral agents
Biological and medical sciences
Diseases of the osteoarticular system
Female
HIV Infections - drug therapy
HIV-1
Humans
Kidney Diseases - chemically induced
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Organophosphonates - adverse effects
Osteomalacia - chemically induced
Osteomalacia - diagnosis
Osteoporosis. Osteomalacia. Paget disease
Pharmacology. Drug treatments
Tenofovir
Tubulopathies
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Summary:We present an HIV-infected woman in whom antiretroviral treatment with tenofovir disoproxil fumarate (TDF) induced severe skeletal pain, synovial effusions and multiple fractures secondary to a Fanconi syndrome with hypophosphatemia and osteomalacia. TDF interferes with the replication of mitochondrial DNA in the proximal tubules of the kidney, which can explain the delayed onset of this form of renal phosphate loss. Nephrotoxicity had been precipitated by cotreatment with lopinavir/r, an HIV protease inhibitor which increases tenofovir serum levels and inhibits the tubular multidrug resistance protein 4, which is responsible for the efflux of tenofovir from tubular cells.Awareness is needed to link the typically prolonged onset of clinical symptoms with TDF exposure and then establish the correct diagnosis.
ISSN:0392-856X
1593-098X