Renal dysfunction and tenofovir toxicity in HIV-infected patients.

Potentially nephrotoxic drugs are only 1 of several causes of renal dysfunction in HIV. Data from the period before the wide use of tenofovir show a variety of prerenal, renal, and obstructive causes of acute renal failure (ARF) in HIV outpatients. Results of clinical trials of tenofovir indicate a rate of ARF of approximately 1%, with observational cohort data indicating a somewhat higher rate. Thus, in evaluating patients with rising serum creatinine levels, including those receiving tenofovir, diagnostic efforts should go beyond discontinuation of potentially offending drugs. This article summarizes a presentation on renal dysfunction in HIV and renal toxicity of antiretroviral drugs made by Lynda A. Szczech, MD, MSCE, at an International AIDS Society-USA Continuing Medical Education course in Washington, DC, in May 2008. The original presentation is available as a Webcast at www.iasusa.org.