Victoria Sharp, MD

A 33-year-old man from the Ivory Coast (who had been living in the United States for the past 8 years) received a diagnosis of AIDS when he presented with Pneumocystis jiroveci pneumonia. His CD4+ cell count was 6/µL, and his HIV RNA level was 575,000 copies/mL. He also presented with altered sensorium and seizure activity and was found to have obstructive hydrocephalus and ring-enhancing lesions in both cerebellar hemispheres and basal ganglia. Results of polymerase chain reaction testing of cerebrospinal fluid for Toxoplasma gondii were positive, and treatment for toxoplasmosis was started. A ventricular-peritoneal shunt was placed.

Tenofovir disoproxil fumarate is a nucleotide reverse transcriptase inhibitor that is usually well tolerated with few adverse effects, but it has been implicated in the development of Fanconi syndrome and renal insufficiency because of its effects on the proximal renal tubule. Vancomycin nephrotoxicity is infrequent but may result from coadministration with other nephrotoxic agents, such as aminoglycosides. We report the cases of 2 patients receiving tenofovir as part of an antiretroviral regimen in whom renal failure developed after a prolonged course of vancomycin.