Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP737

Poster Presentation

TENOFOVIR-ASSOCIATED FANCONI SYNDROME IN CHILDREN WITH HIV INFECTION

Gusti Ayu Nyoman Yulia Sitta Dewi,Ketut Dewi Kumara Wati,Komang Ayu Witarini,Gusti Ayu Putu Nilawati,I Made Arimbawa RSUP Sanglah Department of Child Health Faculty of Medicine Udayana University, Sanglah Hospital

Background : Although recommended as a first-line antiretroviral agent with a favorable safety profile, Tenofovir in our center mostly used as second line. Tenofovir has been recognized as a cause of acquired Fanconi syndrome, a rare disorder characterized by renal tubular dysfunction, which leads to some symptoms as well as symptoms of polyuria and dehydration, which may ultimately lead to defects in bone mineralization and increase risk of fracture. The objective of this case report is to describe two cases tenofovir associated Fanconi syndrome in children with HIV infection in Sanglah hospital. Case Presentation Summary : A 11-year-old girl presented with perinatal acquired HIV diagnosed at age 2.5 years. She has 2 years of lamivudin, tenofovir and lopinavir/ritonavir then presented bilateral foot pain. Laboratory results showed hypokalemia, hypocalcemia, reduced glomerular filtration rate (GFR), glucosuria, and vitamin D insufficiency. Radiographic was normal. Treatment was initiated by replacing tenofovir to abacavir & Vitamin D. Pain resolved and GFR was normalized 2 months later. The second case was 12-year-old boy with perinatal HIV diagnosed at age 2.5 years. After 9 months of lamivudin, tenofovir and lopinavir/ritonavir, he presented bilateral foot pain. Laboratory findings in hypokalemia, hypophosphatemia, reduced GFR, vitamin D insufficiency, proteinuria, glucosuria, and metabolic acidosis. Marked osteoporosis was seen on X-rays of both his ankle joint and knee. Two months after the switched of tenofovir to abacavir therapy, laboratory evaluation showed improvements. He resumed walking 2 months later. Learning Points/Discussion : Fanconi syndrome is an uncommon complication. The renal complication from tenofovir must be suspected in the presence of electrolyte disturbances and generalized bone pain. Routine clinical and biochemical monitoring is essential for proper management and prevention of complications in HIV-infected patients being treated with regiment consisting Tenofovir.

Keywords: tenofovir Fanconi syndrome HIV children