At 50 years old, Anne(name changed) has been a notable success story in Kenyas HIV treatment efforts, having been on antiretroviral therapy (ARVs) for the past 13 years.
Her adherence to her treatment regimen has been exemplary, and she has had no significant health issues related to her HIV status.
She has avoided common symptoms such as coughs, night sweats, back pain, and the nerve damage that can cause a pricking sensation.
However, two years ago, Anne began to experience generalized body aches and bone pains. These symptoms have progressively worsened, culminating in a severe episode three weeks prior to her most recent hospital admission.
During this time, Anne also started experiencing muscle weakness in both her upper and lower limbs.
This new development in her health condition has prompted further medical evaluation to determine the underlying cause of her symptoms, which could potentially be related to long-term ARV use, other chronic conditions, or new health issues.
The healthcare team will likely conduct a thorough assessment, including reviewing her current medication, running diagnostic tests, and possibly adjusting her treatment plan to address her new symptoms and improve her overall quality of life.
“Our patient was initiated on highly active antiretroviral therapy (HAART) in 2011 and has been on her drugs with excellent adherence since then,” doctors confirm.
Despite her excellent adherence to antiretroviral therapy (ART), Anne presented with a concerning clinical picture upon her recent hospital admission.
She had significant weight loss, evidenced by a body mass index (BMI) of 17.8 and a weight of 48 kilograms. She was also immobile due to a recent fall. However, other systemic examinations were normal.
Laboratory investigations revealed serious renal dysfunction, characterized by:
– Poor waste filtration rate by the kidneys
– Elevated blood creatinine levels
– Proteinuria (elevated protein levels in urine)
– Glycosuria (elevated sugar levels in urine)
– Hypocalcemia (too little calcium in the blood)
Creatinine is a waste product produced by muscle metabolism and is usually filtered out by the kidneys. Elevated levels in the blood indicate impaired kidney function.
The doctors diagnosed Anne with Fanconi syndrome, a rare kidney disorder that involves damage to the kidney’s proximal tubules.
This condition can be induced by certain medications. Dr. Fredrick Odhiambo and his colleagues at the Maua Methodist Hospital in Meru identified Tenofovir Disoproxil Fumarate (TDF), a common component of her HIV treatment, as the cause of the damage.
Tenofovir is widely regarded as one of the most effective and tolerable medications for HIV treatment globally.
In 2016, the World Health Organization (WHO) recommended a Tenofovir-based regimen as the first line of treatment for adults and adolescents. However, despite its efficacy, Tenofovir can have nephrotoxic effects in some individuals, leading to conditions such as Fanconi syndrome.
Anne’s case underscores the importance of regular monitoring for potential side effects in patients on long-term ART, even with newer and generally well-tolerated medications like Tenofovir.
Early detection and intervention are crucial to manage and mitigate adverse effects, ensuring the continued health and quality of life for individuals living with HIV.
“Despite its excellent safety profile and tolerability, TDF is known to cause proximal tubule renal dysfunction,” Dr Odhiambo and his colleagues say in a report they published last week in the Clinical Case Reports journal.
The damage to kidney’s tiny tubes can manifest as Fanconi syndrome (FS), acute kidney injury or chronic kidney disease.
Dr Odhiambo now emphasises the importance of monitoring renal function in clients with HIV.
“Patients on TDF-based regimen are at five times greater risk of developing chronic kidney disease in comparison to patients on a non-TDF-based regimen,” he explained.
The prevalence of renal dysfunction induced by Tenofovir Disoproxil Fumarate (TDF) is estimated at 5.6%. Certain factors increase the risk of this side effect, including advanced age, low body mass index (BMI), low baseline CD4 count, hypertension, and diabetes.
Dr. Fredrick Odhiambo, along with his colleagues Shallot Nareeba, Grace Mwangeka, Ann Njambi, and Vashti Nyakebati, highlighted these findings.
In response to her diagnosis of Fanconi syndrome, Anne was switched from TDF to an Abacavir-based regimen. Abacavir is another potent antiretroviral drug used in the treatment of HIV.
Remarkably, within 11 weeks of changing her medication, Anne’s renal function showed significant improvement. Her creatinine levels normalized, proteinuria and glycosuria were resolved, and her muscle strength improved, allowing her to walk with support.
This case underscores the importance of vigilant monitoring for renal dysfunction in patients on TDF, especially those with additional risk factors. It also illustrates the potential for recovery with timely intervention and appropriate adjustment of antiretroviral therapy.
patients on TDF, especially in resource-limited settings where access to routine tests may be constrained,” Dr Odhiambo said.
The report is titled “Tenofovir induced Fanconi syndrome in a middle age African female from Kenya, East Africa: Case report and brief literature review”.
The National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak), says the government needs to support Kenyans who are ageing with HIV.
“The required renal tests every year are expensive and many people cannot afford them,” Nephak CEO Nelson Otwoma said.
“Many people who have been on HIV treatment for a long time have many comorbidities of non-communicable diseases and cannot afford treatment and tests.”
According to Dr Odhiambo’s team, Anne could not afford the necessary annual renal tests.
In the absence of treatment, Fancomi syndrome leads to chronic renal failure. The treatments for kidney failure are dialysis and a kidney transplant.
