Fanconi syndrome in a patient receiving pre-exposure prophylaxis for HIV infection: case report
Douglas Drak
A B * , Jasper Lin C , Andrew Gowers D and David M. Gracey B C D
+ Author Affiliations
- Author Affiliations
A Royal North Shore Hospital, St Leonards, NSW, Australia.
B Faculty of Medicine, Central Clinical School, University of Sydney, Sydney, NSW, Australia.
C Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
D Holdsworth House Medical Practice, College Street, Sydney, NSW, Australia.
Sexual Health 19(3) 224-227 https://doi.org/10.1071/SH21185
Submitted: 24 September 2021 Accepted: 4 May 2022 Published: 26 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: Tenofovir disoproxil is efficacious in the preventing HIV infection as part of a pre-exposure prophylaxis (PrEP) regimen. Although its use has been associated with impaired renal function, instances of Fanconi syndrome are extremely rare. This may change with increased uptake of PrEP.
Methods: A 55-year-old male patient (he/him/his) was commenced on PrEP with a baseline estimated glomerular filtration rate (eGFR) of approximately 60 mL/min/1.73 m2.
Results: Within 6 months, he developed new and worsening proteinuria, glycosuria and aminoaciduria despite no apparent change in eGFR. PrEP was discontinued and his urinary abnormalities rapidly resolved. The patient remains off PrEP.
Conclusions: Fanconi syndrome is a rare, but known complication of tenofovir disoproxil. This is the first report related to PrEP in Australia. While tenofovir associated nephrotoxicity in patients taking PrEP is uncommon, the patient’s age and pre-existing renal impairment placed him at substantially higher risk. At-risk patients need more frequent monitoring of their eGFR and proteinuria. Urinary protein to creatinine ratio is the preferred to dipstick testing for proteinuria and the latter does not readily detect the low molecular wight proteinuria characteristic of tenofovir toxicity. Early recognition of these patients is essential, as prompt cessation of PrEP can often reverse renal abnormalities.
Keywords: emtricitabine, estimated glomerular filtration rate, Fanconi syndrome, HIV prevention, pre-exposure prophylaxis, PrEP, risk reduction, tenofovir disoproxil.
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