Complications
Tenofovir is associated with nephrotoxicity. Renal function should be monitored during treatment. Tenofovir is available as tenofovir disoproxil or the oral prodrug tenofovir alafenamide. Previously tenofovir was avoided in patients with preexisting renal impairment; however, in 2022 the updated British Association for Sexual Health and HIV guidelines recommended tenofovir alafenamide in preference to tenofovir disoproxil in patients with renal impairment as the prodrug is associated with less renal toxicity.[3]
Patients should be monitored closely if otherwise at increased risk for myopathy or rhabdomyolysis at baseline. Creatine phosphokinase should be checked if the patient complains of myalgias or other muscular complaints.
Indirect hyperbilirubinemia caused by atazanavir is not pathogenic, is not associated with any hepatic toxicity, is asymptomatic, and will resolve after discontinuation of the drug. Some patients may prefer to discontinue the drug early if they develop scleral icterus that is cosmetically undesirable.
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