Is Tenofovir Disoproxil Fumarate Best Avoided when Treating Patients with Hepatitis B After Liver Transplantation?

Clinicians with lengthy experience in managing HIV know that prolonged treatment with tenofovir disoproxil fumarate (TDF) may cause renal tubular dysfunction leading to electrolyte and glucose wasting (Fanconi syndrome). The “newer” formulation of tenofovir — tenofovir alafenamide (TAF) — rarely causes Fanconi syndrome. In a retrospective case series, investigators assessed the likelihood of developing this syndrome in 79 recipients of liver transplantation for hepatitis B virus (HBV) infection, 66 of whom also received TDF.

Fanconi syndrome was diagnosed in 12.1% of TDF recipients a mean 36.5 months after starting this medication. Among surviving patients, most were switched to entecavir, and renal dysfunction resolved a mean 13 weeks there…