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August 17, 2010

Tenofovir treatment impairs kidney function, but clinical significance limited “Our systematic review suggests that the risk of clinically relevant renal toxicity due to TDF is relatively low, at least during the short-term,” comment the investigators.

"Nevertheless, they note that “dozens” of cases of tenofovir-associated kidney dysfunction have been reported. The researchers provide a number of explanations for the differences between the findings of their meta-analysis and the outcomes seen in routine practice:

* More sensitive testing of kidney function was used to diagnose the cases seen in “real world” settings.

* Many of the cases seen in clinical practice involved individuals who were also taking ddI (didanosine, Videx, Videx EC) or a ritonavir-boosted protease inhibitor. By contrast, most of the patients in the studies were taking an NNRTI and the use of ddI was scrupulously avoided.

*Many case reports involve older patients, those with advanced HIV disease, and individuals with mild kidney dysfunction at baseline. Such individuals would be excluded from clinical trials.

"Our findings do not support the need to restrict TDF use in jurisdictions where regular monitoring of renal function… is difficult or impractical," conclude the investigators."