Tenofovir-Induced Fanconi Syndrome in an HIV Infected Nigerian: A Case Report

Abstract

Background: While TenofovirDisoproxil Fumarate (TDF) has achieved great success in the treatment of HIV infection, there have been reports of TDFinduced Fanconi syndrome. TDF is a key component of first line antiretroviral regimens with increasing use, particularly in developing countries. Whereas, much attention has been focused on other renal complications of TDF, very little has been studied in Nigeria to address the potential proximal renal tubular dysfunction with its attendant complications, such as osteomalacia. Case Report: We describe the case of a 52 year old HIV infected Nigerian woman on TDF plusEmtricitabine plus ritonavir-boosted LopinavirAntiretroviral Therapy (ART) who presented with osteomalacia and micro fractures due to renal phosphate wasting which resolved following discontinuation of TDF and supplementation with Calcium (Calcium Sandoz 1000mg OD), Vitamin D (Cholecalciferol 1000mg BID and alfacalcidol 0.5mg OD) and Phosphate (Potassium phosphate monobasic, sodium phosphate dibasic dihydrate 1 BID). Conclusion: This case highlights the importance of considering the diagnosis of osteomalacia among HIV infected Nigerians on TDF containing ART. We recommend regular monitoring of renal tubular function, bone alkaline phosphatase