After presenting with fatigue, malaise, and muscle cramps, a 28-yr-old man with history of STIs is diagnosed with new renal failure (Cr >9 mg/dL) and HIV (VL ~3 mil. copies/mL). Drs. Scully and Hoffmann note the missed opportunities for HIV prevention, then review HIV-associated kidney disease and evaluate regimens safe for rapid ART initiation.

References Cited

• Bahr NC, Yarlagadda SG. Fanconi Syndrome and Tenofovir Alafenamide: A Case Report. Ann Intern Med. 2019;170(11):814-815. PMID: 30690644 
• Diana NE, Naicker S. The changing landscape of HIV-associated kidney disease. Nat Rev Nephrol. 2024;20(5):330-346. PMID: 38273026
• Gallant JE, Parish MA, Keruly JC, Moore RD. Changes in renal function associated with tenofovir disoproxil fumarate treatment, compared with nucleoside reverse-transcriptase inhibitor treatment. Clin Infect Dis. 2005;40(8):1194-1198. PMID: 15791522 
• Jiang SX, Duncan J, Ko HH. Acquired Fanconi Syndrome from Tenofovir Treatment in a Patient with Hepatitis B. Case Reports Hepatol. 2023;2023:6158407. Published 2023 Jun 17. PMID: 37362623
• Karris MY. Short Communication: Resolution of Tenofovir Disoproxil Fumarate Induced Fanconi Syndrome with Switch to Tenofovir Alafenamide Fumarate in a HIV-1 and Hepatitis B Coinfected Patient. AIDS Res Hum Retroviruses. 2017;33(7):718-722. PMID: 28403627 

Related Guidelines from the NYSDOH AI Clinical Guidelines Program

• PrEP to Prevent HIV and Promote Sexual Health
• Doxycycline Post-Exposure Prophylaxis to Prevent Bacterial Sexually Transmitted Infections
• Selecting an Initial ART Regimen