Introduction
renal tubular injury
Tenofovir disoproxil fumarate (TDF), a prodrug of tenofovir, is recommended by the WHO as part of first-line antiretroviral therapy (ART) regimens [TDF undergoes esterase hydrolysis, which removes two ester groups to form tenofovir, while TAF undergoes hydrolysis by intracellular cathepsin A to form tenofovir [Studies of tenofovir toxicity in African populations have shown inconsistent results [Because of inconsistent data from pharmacogenomic studies and the limited data regarding the pharmacogenetics of TDF toxicity in Africans, who have the highest genetic diversity worldwide, we evaluated whether laboratory markers of renal tubular injury were associated with polymorphisms in genes involved in TAF, TDF, and tenofovir metabolism and transport among ART-naive Southern Africans who had been randomized to initiate either TDF- or TAF-containing regimens in a prospective clinical trial.