Tenofovir-Associated Kidney Dysfunction and Bone Fracture: A Case Report and Literature Review

Abstract

Tenofovir is an integral part of antiretroviral therapy used to treat HIV. Long-term use of tenofovir has been associated with decreased glomerular filtration rate, leading to chronic kidney disease, as well as acidosis, electrolyte imbalances, and tubular dysfunction. Tenofovir can also disrupt bone health by decreasing renal phosphate absorption, contributing to osteomalacia. This leads to disruption in mineral metabolism, elevated parathyroid hormone levels, and ultimately, low bone mineral density. Replacing tenofovir with alternative antiretroviral therapy can improve kidney function if done early in the course of the disease. Here, we discuss a case of a 65-year-old woman with HIV who presented with advanced renal failure and hypophosphatemia-induced bone fracture attributed to long-term use of tenofovir. We conclude monitoring kidney function and considering alternative antiretroviral therapy is important to prevent and manage these side effects in patients on long-term tenofovir therapy.

Keywords: acquired immune deficiency syndrome (aids); avascular necrosis of femur; avascular necrosis of the hip; drug-induced acute renal failure; femur intertrochanteric fracture; highly active antiretroviral therapy (haart); human immunodeficiency virus (hiv); kidney failure; tenofovir alafenamide (taf); tenofovir disoproxil fumarate (tdf).

Figure 1. Plain X-ray of the matured skeleton.

(A) Anterior-posterior (AP) view of the pelvis with bilateral hip and (B) AP view of the right femur revealing displaced comminuted intertrochanteric fracture (white arrow) of the right femur (Boyd and Griffin’s type 2).