{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:40:47Z","timestamp":1760150447737,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor that has been widely used for the treatment of patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infections. Despite the excellent safety records of this regimen, a few cases of acute renal failure and Fanconi syndrome have been reported among HIV patients exposed to TDF. However, in the HBV monoinfection scenario, only five cases of TDF-associated Fanconi syndrome have been reported thus far, two of them providing a confirmatory kidney biopsy. Here, we describe the case of a 68-year-old woman with chronic hepatitis B (CHB) who developed TDF-induced Fanconi syndrome that reverted after TDF withdrawal from tenofovir alafenamide. Though the overall risk of TDF-associated severe renal toxicity in HBV patients appears to be negligible, both glomerular and tubular functions should be monitored in patients exposed to TDF.<\/jats:p>","DOI":"10.3390\/jcm12227178","type":"journal-article","created":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T01:54:12Z","timestamp":1700445252000},"page":"7178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Tenofovir-Induced Fanconi Syndrome Presenting with Life-Threatening Hypokalemia: Review of the Literature and Recommendations for Early Detection"],"prefix":"10.3390","volume":"12","author":[{"given":"Efstathia","family":"Liatsou","sequence":"first","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioanna","family":"Tatouli","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Mpozikas","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria-Markella","family":"Pavlou","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hariklia","family":"Gakiopoulou","sequence":"additional","affiliation":[{"name":"1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6328-9783","authenticated-orcid":false,"given":"Ioannis","family":"Ntanasis-Stathopoulos","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Gavriatopoulou","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofoklis","family":"Kontogiannis","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-3254","authenticated-orcid":false,"given":"Meletios Athanasios","family":"Dimopoulos","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1086\/380398","article-title":"Efficacy of tenofovir disoproxil fumarate in antiretroviral therapy-naive and -experienced patients coinfected with HIV-1 and hepatitis B virus","volume":"189","author":"Dore","year":"2004","journal-title":"J. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1002\/hep.20464","article-title":"Comparison of adefovir and tenofovir in the treatment of lamivudine-resistant hepatitis B virus infection","volume":"40","author":"Mauss","year":"2004","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S2468-1253(16)30024-3","article-title":"Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: A randomised, double-blind, phase 3, non-inferiority trial","volume":"1","author":"Chan","year":"2016","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"595","DOI":"10.2165\/00003088-200443090-00003","article-title":"Tenofovir disoproxil fumarate: Clinical pharmacology and pharmacokinetics","volume":"43","author":"Kearney","year":"2004","journal-title":"Clin. Pharmacokinet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1111\/liv.14155","article-title":"Ten-year efficacy and safety of tenofovir disoproxil fumarate treatment for chronic hepatitis B virus infection","volume":"39","author":"Marcellin","year":"2019","journal-title":"Liver Int."},{"key":"ref_6","first-page":"354908","article-title":"Tenofovir nephrotoxicity: 2011 update","volume":"2011","author":"Sanz","year":"2011","journal-title":"AIDS Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1038\/ki.2010.318","article-title":"Tenofovir nephrotoxicity: Acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities","volume":"78","author":"Herlitz","year":"2010","journal-title":"Kidney Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1592\/phco.24.4.415.33182","article-title":"Tenofovir-related nephrotoxicity: Case report and review of the literature","volume":"24","author":"James","year":"2004","journal-title":"Pharmacotherapy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s00228-014-1712-z","article-title":"Tenofovir-induced nephrotoxicity: Incidence, mechanism, risk factors, prognosis and proposed agents for prevention","volume":"70","author":"Jafari","year":"2014","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1016\/j.jmii.2019.07.003","article-title":"Effects of long-term exposure to tenofovir disoproxil fumarate-containing antiretroviral therapy on renal function in HIV-positive Chinese patients","volume":"52","author":"Tan","year":"2019","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"381","DOI":"10.3947\/ic.2020.52.3.381","article-title":"Recovery of Tenofovir-induced Nephrotoxicity following Switch from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in Human Immunodeficiency Virus-Positive Patients","volume":"52","author":"Seo","year":"2020","journal-title":"Infect. Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1097\/QAD.0b013e3280b07b33","article-title":"The safety of tenofovir disoproxil fumarate for the treatment of HIV infection in adults: The first 4 years","volume":"21","author":"Nelson","year":"2007","journal-title":"Aids"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1053\/ajkd.2002.36924","article-title":"Fanconi syndrome and renal failure induced by tenofovir: A first case report","volume":"40","author":"Verhelst","year":"2002","journal-title":"Am. J. Kidney Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/00126334-200403010-00007","article-title":"Renal tubular dysfunction associated with tenofovir therapy: Report of 7 cases","volume":"35","author":"Reynes","year":"2004","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1097\/QAD.0b013e3283262a64","article-title":"Kidney tubular abnormalities in the absence of impaired glomerular function in HIV patients treated with tenofovir","volume":"23","author":"Labarga","year":"2009","journal-title":"Aids"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1097\/QAD.0b013e32833202e2","article-title":"Impairment in kidney tubular function in patients receiving tenofovir is associated with higher tenofovir plasma concentrations","volume":"24","author":"Labarga","year":"2010","journal-title":"Aids"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"945","DOI":"10.3851\/IMP2649","article-title":"Tenofovir-associated Fanconi syndrome in patients with chronic hepatitis B monoinfection","volume":"18","author":"Gracey","year":"2013","journal-title":"Antivir. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1002\/hep.27730","article-title":"Tenofovir-associated Fanconi syndrome and nephrotic syndrome in a patient with chronic hepatitis B monoinfection","volume":"62","author":"Hwang","year":"2015","journal-title":"Hepatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.jcv.2014.09.016","article-title":"Tenofovir-induced Fanconi syndrome in chronic hepatitis B monoinfected patients that reverted after tenofovir withdrawal","volume":"61","author":"Brocchieri","year":"2014","journal-title":"J. Clin. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12981-021-00380-w","article-title":"Tenofovir alafenamide nephrotoxicity: A case report and literature review","volume":"18","author":"Ueaphongsukkit","year":"2021","journal-title":"AIDS Res. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1097\/QAD.0b013e3283313f54","article-title":"Tenofovir\/probenecid combination in HIV\/HBV-coinfected patients: How to escape Fanconi syndrome recurrence?","volume":"24","author":"Izzedine","year":"2010","journal-title":"Aids"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1038\/ki.2008.252","article-title":"Rosiglitazone reverses tenofovir-induced nephrotoxicity","volume":"74","author":"Andrade","year":"2008","journal-title":"Kidney Int."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"(2017). EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J. Hepatol., 67, 370\u2013398.","DOI":"10.1016\/j.jhep.2017.03.021"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1002\/hep.29800","article-title":"Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance","volume":"67","author":"Terrault","year":"2018","journal-title":"Hepatology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/22\/7178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:25:55Z","timestamp":1760131555000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/22\/7178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,20]]},"references-count":24,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["jcm12227178"],"URL":"https:\/\/doi.org\/10.3390\/jcm12227178","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,11,20]]}}}