Tenofovir Side Effects

Human immunodeficiency virus (HIV) is a very dangerous viral infection. Fortunately, there is an effective remedy called tenofovir that helps to treat HIV-1 and significantly helps patients to overcome the negative consequences of the disease. But if you are going to start treatment, you should know which side effects to expect. The following article will clarify this issue.

Hepatitis B is considered the world’s most serious liver infection. It has been found to be somewhere between 50 and 100 times more infectious than the human immunodeficiency virus (AIDS). It is also the main cause of liver cancer, which is the second foremost cause of cancer deaths worldwide.

According to the United Nations, as of 2017, close to 36.9 million people all over the world were HIV/AIDS-positive. This same report also indicated that about 940,000 people died from complications related to AIDS that same year. The numbers have actually dropped over the years due to the development of anti-retroviral drugs.

The world was relieved in 1987 when AZT gained approval from the US FDA (Food and Drug Administration) for the treatment of HIV/AIDS. This began the era of anti-retroviral drugs, one of which is tenofovir.

TDF (tenofovir disoproxil fumarate) belongs to the class of drugs referred to as NRTIs (nucleoside reverse transcriptase inhibitors). 300 mg of this drug (equivalent to 245 mg of tenofovir disoproxil) combined with 300 mg of emtricitabine serves as an active ingredient for the drug, Truvada, used in PrEP (pre-exposure prophylaxis). Its presence as an active ingredient in microbicides has lowered the risk of HIV infection in women who used it by 39% as shown through a study [1].

TDF is marketed with the name Viread (brand name) by Gilead Sciences Inc. When used alongside other antiretroviral medicines, it becomes effective for the treatment of HIV. However, for the treatment of hepatitis, it is effective as a single agent. Tenofovir reduces the viral load in the body of a patient by obstructing reverse transcriptase.

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🔍What Are Tenofovir Side Effects?

During the initial development of tenofovir, there were concerns that it may cause kidney toxicity. However, all through the testing and development of the medication, not a single case of kidney toxicity was reported. Nevertheless, over time, users of tenofovir have complained of experiencing some adverse effects such as dizziness, stomach pain, diarrhea, weakness, headache, rash or itching and trouble falling or staying asleep.

🤧Common Adverse Reactions

Many users have reported some adverse reactions after taking the medication. Some of such reactions include:

  • high cholesterol: The body needs cholesterol to build healthy cells, but when in excess, there’s a risk that it could lead to heart disease. So in an attempt to manage hepatitis B or HIV, users of tenofovir may complicate issues by increasing the body’s cholesterol levels. A doctor or healthcare provider should be informed of any underlying health conditions before going ahead with tenofovir;
  • pneumonia: Pneumonia refers to an infection in one or both lungs. This is another adverse reaction that users of tenofovir have reported;
  • sinus irritation and congestion: Sinus irritation and congestion may be experienced in the nasal passage due to the use of tenofovir;
  • depression: This is a serious medical disorder that brings about negative feelings, thoughts, and actions. Depression accounts for most cases of suicides and unfortunately, it is suspected to be an adverse reaction of this med. Complains of depression resulting from the use of this drug is extremely rare;
  • rash: tenofovir sometimes causes rashes. Adverse reactions of this nature mostly surface during the early stage of using the drug and disappear as the body gets accustomed to it;
  • slightly lower infant height: Though the use of tenofovir during pregnancy has been found to be safe, slightly lower infant height (at age 1) was shown by one study. However, the significance of this eventuality is not quite clear.

The most common reactions that may be experienced with the use of tenofovir rarely require medical attention as they vanish within just a few days. The discomforts usually disappear while taking the medication as the body gets used to it. However, if they persist, an immediate report should be made to a healthcare center for adequate medical attention. Also, health care providers should be able to tell you how to avoid or reduce these side effects. Therefore, talk to your doctor for professional advice before taking tenofovir.

🤒Rare Side Effects of Tenofovir

There are some tenofovir side effects that are very uncommon. Apparently, they are considered uncommon because not all users experience them, and those that do are very few. Examples of these negative side effects include:

  • decreased appetite;
  • diabetes insipidus along with kidney complications;
  • Fanconi’s syndrome (insufficient reabsorption in the kidney proximal renal tubules);
  • giant hives;
  • hearing loss;
  • Graves’ disease (an autoimmune disorder);
  • Guillain-Barre syndrome (an uncommon neurological disorder marked by an accidental attack by the immune system against the nerves);
  • increase of blood acidity as a result of very high lactic acid levels;
  • inflammation of several voluntary muscles in different body parts;
  • mitochondrial toxicity;
  • interstitial nephritis (the inflammation of the kidney interstitium);
  • low blood-phosphate level;
  • low blood-potassium level;
  • anxiety;
  • peripheral neuropathy (pain, numb feeling or weakness due to nerve damage, mostly in the hands and feet);
  • rhabdomyolysis (the breakdown of the tissues in the muscle, releasing toxic protein into the blood);
  • difficulty with breathing;
  • kidney stones, also known as nephrolithiasis;
  • sweating profusely;
  • a high concentration of triglyceride in the blood;
  • a weakness of the muscles.

Also, major liver complications and a condition called lactic acidosis can develop rarely in patients who use tenofovir. If you notice any of these symptoms, make sure to consult your doctor quickly.

⏱Long Term TDF Side Effects

At the moment, there is no scientifically tested cure for HIV and hepatitis B. Hence, most patients rely on anti-retroviral drugs like tenofovir, which has to be taken continuously for healthy living. As a result, many people have to take tenofovir all their lives.

While negative side effects such as nausea, abdominal pain and vomiting, among a few others, are common with the short-term use of tenofovir, there’s a scientific suggestion that continuous use (i.e. long-term use) may result in long-term negative side effects. However, these side effects are subject to confirmation through randomized clinical trials.

A few of these long-term side effects are listed below.

Toxicity Risk

There is a risk of long term tenofovir users developing abnormal levels of creatinine in their blood. Creatinine is a waste product formed by the normal breakdown of muscle cells. The excess level of it in the blood, therefore, is an indication of possible kidney malfunction.

Kidney Failure

With the continued intake of tenofovir, there is a risk of kidney failure. This is because the drug is filtered by the kidneys. Kidney failure, which is sometimes referred to as ESRD (end-stage renal disease), refers to the point where the kidney stops working and cannot function without dialysis or a kidney transplant. It is the last phase of persistent kidney disease. No one should ever let their condition get to this state before seeking medical attention.

Liver Enlargement

Also known as Hepatomegaly, this is a condition in which the liver increases beyond its regular size. Usually, other symptoms such as fatigue, jaundice and filling up early after a meal accompany liver enlargement.

🔬Exacerbation of Hepatitis B Virus

A potential complication or worsening of the hepatitis B condition is one long-term adverse effect of tenofovir. It is on this account that patients suffering from hepatitis and taking tenofovir as medication are advised to make regular visits to a healthcare provider or medical professional for consultation and checkup.

⚠Other Serious Health Risks

Other health risks that may surface with the use of tenofovir are renal tubular necrosis, pancreatitis (inflammation of the pancreas), softening of the bones or bone loss, among others. However, these health risks have not been confirmed to take place with long-term use of the drug. Results from the trials carried out in regards to these health risks did were not absolute, are suggestive, and have yet to be confirmed. Regardless, users must avoid stopping treatment with tenofovir abruptly as this could lead to some complications.

📋Important Precautionary Measures

It is important to note that tenofovir does not work well with other medications that contain tenofovir. This combination may lead to the surfacing of other negative aftereffects. Some examples of such drugs that already contain tenofovir are:

  • Truvada;
  • Atripla;
  • Complera;
  • Stribild.

There are also certain classes of drugs that do not go well with tenofovir with long-term use. Some of them include [2]:

  • antidiabetic (empagliflozin);
  • antidepressants;
  • analgesics (ibuprofen, aspirin);
  • antifungals.

Once started, tenofovir should not be stopped except if otherwise stated by the doctor. Discontinuation of the medication without a doctor’s recommendation may result in acute exacerbation of hepatitis.

Also, tenofovir does not reduce the risk of transferring HIV to others as it is just a component of the actual drug that does. Hence, even while taking tenofovir, the need to continually practice safe sex, and observe other precautionary measures such as avoiding the sharing of sharp objects is of chief importance.

✋Avoid Side Effects While Taking Tenofovir

It is clear that side effects are inseparable from the use of tenofovir. It is also clear that there are mild side effects that surface during the initial use of the drug, as well as those that may surface after a long period of time.

While users can expect very mild side effects such as headaches, dizziness or stomach upset, and wait a day or two to see if they go away, a doctor should be notified if they do not go away after a while.

To be on the safe side, irrespective of the type of negative side effect that may be experienced, the best and surest step to take is to notify a healthcare provider or doctor immediately. They are professionals and would know how to calm the situation, what tests to do and the next course of action. Also, users should strive to avoid missing doses. Mnemonic devices can be used to help remember dosing time. This can be achieved by associating dosing time with a word, an image or a phrase. More information on tenofovir, other antiretroviral agents, as well as HIV/AIDS can be found on HIVPrEP.


  1. Tenofovir-based microbicide gel reduces risk of infection for women by 39%. Keith Alcorn. Retrieved 19 July 2010. aidsmap.com
  2. Long-term use medications and TDF/FTC PrEP. University of Liverpool. hiv-druginteractions.org. Revised December 2017.
Logan Morris

Expert in pharmaceutical practice and antiviral medicine, founder of HIVPrEP. Main goal is to popularize HIV topics and create awareness for global masses on how to prevent the disease and how to use HIV medication safely.

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