Zimmermann Anthony E, Pizzoferrato Thomas, Bedford John, Morris Anne, Hoffman Robert, Braden Gregory
Massachusetts College of Pharmacy and Health Science, Worcester, Massachusetts, USA.
Clin Infect Dis. 2006 Jan 15;42(2):283-90. doi: 10.1086/499048. Epub 2005 Dec 8.
Tenofovir therapy in patients with human immunodeficiency virus (HIV) infection has been associated with acute renal failure (ARF) and Fanconi syndrome. In the past 2 years, we diagnosed tenofovir-associated ARF in 5 HIV-infected patients who were receiving tenofovir therapy and who had classic findings of acute tubular necrosis, and we compared findings for our patients with data on 22 patients described in the literature. The mean serum creatinine level increased from 0.9 to 3.9 mg/dL, and it decreased to 1.2 mg/dL during recovery. ARF resolved in 22 of 27 patients after discontinuation of tenofovir therapy. The most common drugs given with tenofovir were ritonavir or lopinavir-ritonavir (21 of 27 patients), atazanavir (5 of 27 patients), and didanosine (9 of 27 patients). Tenofovir-associated ARF manifests as acute tubular necrosis that may not resolve with tenofovir withdrawal. Tenofovir is associated with multiple drug interactions, leading to an increased risk of ARF. Frequent monitoring of renal function is warranted for any patient receiving these combinations.
在感染人类免疫缺陷病毒（HIV）的患者中，替诺福韦治疗与急性肾衰竭（ARF）和范科尼综合征有关。在过去2年里，我们诊断出5例接受替诺福韦治疗的HIV感染患者出现了与替诺福韦相关的ARF，这些患者具有急性肾小管坏死的典型表现，并且我们将我们患者的检查结果与文献中描述的22例患者的数据进行了比较。血清肌酐平均水平从0.9mg/dL升至3.9mg/dL，恢复过程中降至1.2mg/dL。27例患者中有22例在停用替诺福韦治疗后ARF得到缓解。与替诺福韦联合使用最常见的药物是利托那韦或洛匹那韦-利托那韦（27例患者中有21例）、阿扎那韦（27例患者中有5例）和去羟肌苷（27例患者中有9例）。与替诺福韦相关的ARF表现为急性肾小管坏死，停用替诺福韦后可能无法缓解。替诺福韦与多种药物相互作用有关，导致ARF风险增加。对于接受这些联合用药的任何患者，都有必要经常监测肾功能。
