Abstract: Most reverse transcriptase inhibitors among antiretroviral therapy drugs are predominantly eliminated via the renal pathway. Drug accumulation may exert an adverse impact on renal function in HIV-infected patients. Among these agents, the nephrotoxicity of tenofovir disoproxil fumarate has long been a major concern, as its relatively high plasma tenofovir exposure is associated with an increased risk of renal and skeletal adverse events. Tenofovir alafenamide is a prodrug of tenofovir, which exhibits high virologic suppression efficacy while reducing plasma tenofovir exposure by approximately 90%. Consequently, tenofovir alafenamide has a significantly lower potential for renal toxicity compared with tenofovir disoproxil fumarate. Numerous clinical trials and real-world studies have demonstrated that antiretroviral therapy regimens containing tenofovir alafenamide confer favorable renal safety profiles in HIV-infected patients. This review summarizes the current evidence and relevant literature regarding the renal safety of tenofovir alafenamide-containing antiretroviral therapy regimens in HIV-infected patients with different renal function statuses, aiming to provide clinical guidance and references for the rational use of tenofovir alafenamide in the treatment of HIV-infected patients.

Key words: Human immunodeficiency virus infected, Tenofovir alafenamide, Antiretroviral therapy, Renal safety