{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T19:48:42Z","timestamp":1761508122553,"version":"build-2065373602"},"reference-count":20,"publisher":"CSIRO Publishing","issue":"3","license":[{"start":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T00:00:00Z","timestamp":1755302400000},"content-version":"vor","delay-in-days":1178,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,28]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tenofovir disoproxil is efficacious in the preventing HIV infection as part of a pre-exposure prophylaxis (PrEP) regimen. Although its use has been associated with impaired renal function, instances of Fanconi syndrome are extremely rare. This may change with increased uptake of PrEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 55-year-old male patient (he\/him\/his) was commenced on PrEP with a baseline estimated glomerular filtration rate (eGFR) of approximately 60\u00a0mL\/min\/1.73\u00a0m2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Within 6\u00a0months, he developed new and worsening proteinuria, glycosuria and aminoaciduria despite no apparent change in eGFR. PrEP was discontinued and his urinary abnormalities rapidly resolved. The patient remains off PrEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fanconi syndrome is a rare, but known complication of tenofovir disoproxil. This is the first report related to PrEP in Australia. While tenofovir associated nephrotoxicity in patients taking PrEP is uncommon, the patient\u2019s age and pre-existing renal impairment placed him at substantially higher risk. At-risk patients need more frequent monitoring of their eGFR and proteinuria. Urinary protein to creatinine ratio is the preferred to dipstick testing for proteinuria and the latter does not readily detect the low molecular wight proteinuria characteristic of tenofovir toxicity. Early recognition of these patients is essential, as prompt cessation of PrEP can often reverse renal abnormalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh21185","type":"journal-article","created":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T22:17:26Z","timestamp":1653517046000},"page":"224-227","source":"Crossref","is-referenced-by-count":2,"title":["Fanconi syndrome in a patient receiving pre-exposure prophylaxis for HIV infection: case report"],"prefix":"10.1071","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6900-2029","authenticated-orcid":true,"given":"Douglas","family":"Drak","sequence":"first","affiliation":[{"name":"ARoyal North Shore Hospital, St Leonards, NSW, Australia."},{"name":"BFaculty of Medicine, Central Clinical School, University of Sydney, Sydney, NSW, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2660-3558","authenticated-orcid":true,"given":"Jasper","family":"Lin","sequence":"additional","affiliation":[{"name":"CRenal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Gowers","sequence":"additional","affiliation":[{"name":"DHoldsworth House Medical Practice, College Street, Sydney, NSW, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Gracey","sequence":"additional","affiliation":[{"name":"BFaculty of Medicine, Central Clinical School, University of Sydney, Sydney, NSW, Australia."},{"name":"CRenal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia."},{"name":"DHoldsworth House Medical Practice, College Street, Sydney, NSW, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2022,5,26]]},"reference":[{"issue":"11","key":"2025102615415627200_R1","doi-asserted-by":"publisher","first-page":"e629","DOI":"10.1016\/S2352-3018(18)30215-7","article-title":"Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study.","volume":"5","author":"Grulich","year":"2018","journal-title":"Lancet HIV"},{"issue":"5","key":"2025102615415627200_R2","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1053\/j.ajkd.2011.01.022","article-title":"Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence.","volume":"57","author":"Hall","year":"2011","journal-title":"Am J Kidney Dis"},{"issue":"9","key":"2025102615415627200_R3","doi-asserted-by":"publisher","first-page":"3144","DOI":"10.1128\/AAC.00350-08","article-title":"Chronic administration of tenofovir to rhesus macaques from infancy through adulthood and pregnancy: summary of pharmacokinetics and biological and virological effects.","volume":"52","author":"Van Rompay","year":"2008","journal-title":"Antimicrob Agents Chemother"},{"issue":"14","key":"2025102615415627200_R4","doi-asserted-by":"publisher","first-page":"2319","DOI":"10.1097\/QAD.0000000000003035","article-title":"Renal impairment in a large-scale HIV pre-exposure prophylaxis implementation cohort.","volume":"35","author":"Drak","year":"2021","journal-title":"AIDS"},{"issue":"11","key":"2025102615415627200_R5","doi-asserted-by":"publisher","first-page":"e521","DOI":"10.1016\/S2352-3018(16)30153-9","article-title":"Association of age, baseline kidney function, and medication exposure with declines in creatinine clearance on pre-exposure prophylaxis: an observational cohort study.","volume":"3","author":"Gandhi","year":"2016","journal-title":"Lancet HIV"},{"issue":"5","key":"2025102615415627200_R6","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/QAI.0000000000001129","article-title":"Preexposure prophylaxis for hiv prevention in a large integrated health care system: adherence, renal safety, and discontinuation.","volume":"73","author":"Marcus","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2025102615415627200_R7"},{"key":"2025102615415627200_R8","unstructured":"The Australasian Society of HIV and Sexual Health Medicine (ASHM). 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