Critical appraisal and update on tenofovir in management of human immunodeficiency virus infection

Tenofovir is currently one of the most widely used nucleoside reverse transcriptase inhibitors in the treatment of human immunodeficiency virus (HIV) due to its good efficacy, tolerability, and convenience as a once-daily dosage. It is a drug of choice both for first-line therapy in naive and pretreated patients, along with two other active drugs as part of a highly active antiretroviral therapy. Moreover, tenofovir can be used to treat hepatitis B virus-infected patients as well as coinfected patients who meet criteria to be treated for HIV or hepatitis B virus infection, and more recently some studies have supported its use as part of pre-exposure prophylaxis. Although large clinical trials and postmarketing studies have shown a gentle renal profile for tenofovir, some prospective cohort studies and case reports have raised concern about renal damage and bone disorders associated with use of tenofovir in a small proportion of patients, and apprehension lingers over its long-term usage. Renal toxicity from tenofovir seems to be linked to tubular damage, so classical markers for monitoring renal function that mainly assess glomerular function would not be advisable to detect early renal impairment. Management of toxicity associated with tenofovir should be based on assessment of optimal biomarkers for the detection and monitoring of renal disease.