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Tenofovir nephrotoxicity: focusing research questions and putting them into clinical context.

Multiple reports have indicated that the antiretroviral drug tenofovir has renal toxicity [1-9]. However, beyond simply identifying the existence of this potential toxicity, the key clinical questions that we as providers rely on to assist us in understanding which patients are at highest risk and how often to assess for toxicity have not really been answered. The study by Goicoechea et al. [10] in this issue of the Journal takes a key step in helping us to address at least part of this first question. Moreover, this study raises many other points worthy of discussion. Goicoechea et al. compared kidney function over time among 3 cohorts of patients receiving tenofovir disoproxil fumarate (TDF) plus a ritonovir-boosted protease inhibitor (PI), TDF plus a nonnucleoside reverse-transcriptase inhibitor (NNRTI), and regimens not containing TDF. By use of either the CockcroftGault or the Modification of Diet in Renal