ABSTRACT
OBJECTIVES: The aims of the study were to describe the clinical presentation and renal and bone abnormalities in a case series of HIV-infected patients receiving treatment with tenofovir (TDF), and to recommend appropriate screening for toxicity related to TDF. METHODS: Patients were identified from referrals to a specialist HIV renal clinic. Patients were included if treatment with TDF was assessed as the primary cause of the renal function impairment and clinical data were available prior to and following discontinuation of TDF treatment. Data were collected from case note review and clinic databases. RESULTS: Twenty-two patients (1.6% of all those who received TDF) were identified with TDF-associated renal toxicity. All had normal serum creatinine prior to TDF therapy. All presented with proteinuria. On stopping TDF, renal function improved. Eight patients had confirmed Fanconi syndrome. Twelve patients presented with bone pain and osteomalacia was confirmed on an isotope bone scan in seven of these patients. The findings (in those patients tested) of tubular proteinuria, reduced tubular transport maximum of phosphate (TmP), and glycosuria were all consistent with the proximal tubule being the site of toxicity. CONCLUSION: Renal toxicity remains a concern in patients treated with TDF. Clinical presentation may be with renal dysfunction, Fanconi syndrome or osteomalacia. Our investigations suggest proximal tubular toxicity as a common pathogenic mechanism.
Subject(s)
Adenine/analogs & derivatives , Anti-HIV Agents/adverse effects , HIV Infections/drug therapy , Kidney Diseases/chemically induced , Kidney Tubules, Proximal/drug effects , Organophosphonates/adverse effects , Osteomalacia/chemically induced , Adenine/adverse effects , Adult , Creatinine/blood , Creatinine/urine , Fanconi Syndrome/chemically induced , Female , Glycosuria/chemically induced , Humans , Kidney Diseases/urine , Kidney Function Tests/methods , Kidney Tubules, Proximal/metabolism , Male , Mass Screening/methods , Middle Aged , Osteomalacia/diagnostic imaging , Proteinuria/chemically induced , Radionuclide Imaging , TenofovirABSTRACT
BACKGROUND: HIV infection continues to rise in men who have sex with men (MSM) in the UK. Of concern are the high rates of sexually transmissible infections (STI) among HIV-positive MSM, as this is associated with onward HIV transmission. Conventional partner notification (PN) may be limited in this group by the presence of multiple non-contactable partners and the fear of breach of HIV status. METHODS: We explored attitudes to PN in HIV-positive MSM having an STI screen using a computer-assisted self interview. RESULTS AND CONCLUSION: Our study shows HIV+ MSM, rate conventional methods of PN highly (median rating 8/10) but are also supportive of new approaches to PN particularly anonymous email when linked to website information. They would also be open to targeted interventions such as peer recruitment.