What is a major side effect of Tenofovir?

Appeared in: AIIMS CRE 2025

Explanation

Nephrotoxicity (kidney damage) is a well-documented and major adverse effect of Tenofovir, particularly the tenofovir disoproxil fumarate (TDF) formulation.
The drug is eliminated by the kidneys, and high concentrations can accumulate in the proximal renal tubules, causing cellular injury.
This toxicity can manifest as acute renal failure or Fanconi syndrome, a condition characterized by impaired reabsorption in the proximal tubules.
Regular monitoring of serum creatinine and urinalysis is essential for early detection.

Option A: While a flare of hepatitis B can occur upon discontinuation in co-infected patients, severe on-treatment hepatotoxicity is not a characteristic major side effect of Tenofovir itself. Other antiretrovirals are more noted for this.
Option C: Tenofovir is not primarily associated with neurotoxicity. The provided texts do not link it to this side effect.
Option D: Cardiotoxicity is not a recognized major side effect of Tenofovir.

Visual 1: Diagram: A diagram of the kidney nephron, highlighting the proximal tubule. This helps visualize the specific site where Tenofovir can accumulate and cause the damage leading to Fanconi syndrome.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Adverse effects of antiretroviral medication (Tenofovir) as background academic context rather than a clinical decision trigger.
Nurses play a critical role in monitoring for Tenofovir toxicity by tracking lab results, including serum creatinine, eGFR, and urine protein/glucose, and reporting trends to the provider.
Patient education is key. Nurses must teach patients to report signs of kidney dysfunction (e.g., swelling in the legs, fatigue) or bone problems (e.g., persistent pain).
What if? If a patient is taking the newer formulation, Tenofovir Alafenamide (TAF), the risk of nephrotoxicity and bone density loss is significantly lower than with Tenofovir Disoproxil Fumarate (TDF). However, TAF is associated with a greater risk of weight gain and lipid elevations, shifting the monitoring focus.

How to Approach the Question

First, identify the drug in the question: Tenofovir.
Classify the drug: It is a Nucleotide Reverse Transcriptase Inhibitor (NRTI) used for HIV and Hepatitis B.
Recall or look for the hallmark, most clinically significant side effects associated with this specific drug. For pharmacology questions, often one major toxicity defines the drug's safety profile.
Evaluate each option. Nephrotoxicity is a widely known and tested-on side effect of Tenofovir (TDF).
Eliminate the other options by associating them with other drug classes or recognizing they are not primary effects of Tenofovir.

Concept Tested & Keywords

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KD Tripathi - Essentials of Medical Pharmacology (6th Edition) p. 56-58

Practise the full AIIMS CRE 2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.