Fanconi syndrome and nephrogenic diabetes insipidus associated with didanosine therapy in HIV infection: a case report and literature review

Abstract

HIV-infected patients are now treated with combined antiretroviral therapy (CART). Many drugs and/or metabolites are excreted by the kidneys. Furthermore, HIV-infected patients have a high prevalence of preexisting nephropathies, which may or may not be related to HIV [1]. The nucleotide reverse transcriptase inhibitor tenofovir induces tubulopathies and renal insufficiency [2–4]. Nucleoside analogs essentially have mitochondrial toxicity. Nephrotoxicity of these nucleoside analogs is rare. Indeed, didanosine has a good kidney safety profile and only two cases of severe tubular toxicity have been reported [5,6]. Various authors have raised questions about the cumulative nephrotoxicity of didanosine and tenofovir and their respective roles, as their association leads to unexpected side effects in the kidney [7]. Here, we report a case of Fanconi syndrome and nephrogenic diabetes insipidus in an HIV-infected patient receiving a CART regimen including didanosine. We also review the cases that have been published previously, including patients treated with didanosine alone or in combination with tenofovir. We highlight the toxic role of didanosine in this association.