Renal toxicity and bone density loss have been reported in HIV-infected patients treated with tenofovir DF[Fontana 2009; Grigsby 2010]
Tenofovir AF, a new formulation of tenofovir with reduced bone and kidney toxicity as compared with tenofovir DF,[Chan 2016; Buti 2016] was recently approved for the treatment of chronic HBV in the setting of compensated liver disease[FDA TAF]
Telbivudine is associated with increases in creatine kinase, and myopathy, although it also appears to improve creatinine clearance[FDA Telbivudine; Gane 2014]
The combination of telbivudine with peginterferon is contraindicated
Nucleos(t)ide analogues generally have favorable adverse event profiles. However, all nucleos(t)ide analogues theoretically pose a risk of adverse events because most agents inhibit not only viral but also human DNA polymerases.[Fontana 2009] In addition, some agents inhibit human mitochondrial DNA polymerases that may result in a clinical syndrome including lactic acidosis, neuropathy, and myopathy.[Fontana 2009] Fortunately, most nucleos(t)ide analogues used for chronic hepatitis B virus (HBV) infection have shown few adverse events during the first years of therapy, although it should be noted that most studies were performed in relatively healthy patients with compensated liver disease. A recent population-based study confirmed the relative safety of nucleo(s)tide analogues regarding renal and bone events, although there was an increase of hip fractures with nucleotides when compared with nucleosides (HR: 5.69; P = .001).[Wong 2015] The absolute risk, however, remains very low. Lamivudine treatment had similar rates of adverse events compared with placebo in a randomized study,[Dienstag 1999] and the adverse event profile of entecavir was indistinguishable from that of lamivudine.[Chang 2006] By contrast, adefovir is known to be nephrotoxic in up to one third of patients.[Izzedine 2004] Renal toxicity has also been described in HIV-infected patients treated with tenofovir DF, necessitating creatinine monitoring, especially during prolonged treatment.[Fontana 2009] Bone density loss has been reported as well in patients receiving tenofovir DF.[Grigsby 2010] Nevertheless, tenofovir DF was well tolerated and safe during the first 5 years of therapy in patients with chronic HBV infection.[Marcellin 2008b;Marcellin 2013] Tenofovir AF, a new formulation of tenofovir recently approved for the treatment of chronic HBV infection in the setting of compensated liver disease,[FDA TAF] was shown to have reduced bone and kidney toxicity as compared with tenofovir DF in 2 phase III studies.[Chan 2016; Buti 2016] A study of patients with advanced liver disease showed that entecavir therapy in patients with a Model for End-Stage Liver Disease score of > 20 may be associated with the occurrence of severe lactic acidosis,[Lange 2009] although lactic acidosis is a risk with all nucleoside analogues. Lactic acidosis was self-limiting or resolved after entecavir discontinuation in the majority of cases, although 1 fatality was reported.[Lange 2009] Increases in creatine kinase, as well as myopathy, may be observed in a limited number of patients receiving telbivudine,[FDA Telbivudine] although notably, telbivudine appears to improve creatinine clearance.[Gane 2014] The combination of telbivudine with peginterferon is contraindicated because of an increased risk of peripheral neuropathy.[FDA Telbivudine]