Tenofovir-induced quadriparesis

Abstract

With an ever-increasing trend in the side effects of antiretroviral therapy (ART), usage of new regimens to decrease the mortality and morbidity has come into picture. Here we report a case of tenofovir-induced hypokalemic paralysis. A 60-year-old female patient came to a medical outpatient department with quadriparesis. History revealed that she was diagnosed with HIV 6 years back and was on zidovudine, lamivudine, and efavirenz. Three months later, she developed severe anemia because of which zidovudine was replaced by tenofovir. On evaluation, there was hypokalemia with appropriate electrocardiography changes. As previous literature showed association of hypokalemia with tenofovir, we attributed this finding to the usage of tenofovir. ART was stopped, and the patient was given potassium supplements and potassium-rich diet. There was dramatic improvement with the treatment and the patient regained muscle strength. After 1 week, she was put on other alternative regimen consisting of abacavir, lamivudine, and efavirenz. Her CD4 count was improved without any complaints. The patient was monitored on outpatient basis in ART center.