Changes in renal function associated with tenofovir disoproxil fumarate treatment, compared with nucleoside reverse-transcriptase inhibitor treatment. Clin. Infect. Dis

In our large observational cohort, use of tenofovir disoproxil fumarate ( ) was associated with a greater decline innp 344 renal function than was use of alternative nucleoside ana-logues (). Other associations included a lower CD4np 314 cell count, decreased renal function at baseline, and diabetes. The declines were modest and did not lead to greater rates of discontinuation of therapy. Tenofovir disoproxil fumarate (TDF) is the first nucleoside re-verse-transcriptase inhibitor (NRTI) approved by the US Food and Drug Administration for the treatment of HIV disease. It is renally excreted via a combination of glomerular filtration and active tubular secretion. Adefovir dipivoxil, a related NRTI, caused proximal renal tubular dysfunction at a dosage of 60– 120 mg/day, which is required to inhibit HIV replication [1]. However, in clinical trials, TDF has demonstrated an excellent renal safety profile. In the Gilead Sciences 903 trial, in which 299 treatment-naive patients received TDF in combination with lamivudine and efavirenz, there were no instances of renal fail-ure or grade 3/4 elevations in the serum creatinine level through 144 weeks, and there were no significant differences in renal function, compared with that of patients taking stavudine [2, 3]. Nevertheless, renal impairment, including but not limited to proximal renal tubular dysfunction, has been reported to be associated with TDF use [4–11]. The majority of cases of renal impairment have occurred in patients with underlying systemi