PURPOSE OF REVIEW: The antiviral agent tenofovir is highly effective for the 
treatment of HIV and hepatitis B virus infections, and the older prodrug 
tenofovir disoproxil fumarate (TDF) is also a component of daily preexposure 
prophylaxis (PrEP) to reduce the risk of HIV infection in high-risk populations. 
Although TDF is well tolerated, the potential for kidney and bone toxicity has 
important implications for public health given the large number of individuals 
exposed to TDF worldwide. This review summarizes the recent literature on kidney 
and bone health in individuals treated with TDF and the newer prodrug tenofovir 
alafenamide (TAF).
RECENT FINDINGS: Risk factors for TDF toxicity appear to be similar in patients 
treated for HIV or hepatitis B virus and in HIV-uninfected PrEP users, although 
drug-drug interactions are a more important concern in HIV-positive individuals. 
The risk of toxicity appears to be lower with TAF, but further studies are 
needed to confirm the safety of long-term use and to evaluate the efficacy of 
TAF-based PrEP.
SUMMARY: Nephrologists should be aware of the potential kidney and bone toxicity 
of TDF, as well as unique situations in which the newer prodrug TAF may 
contribute to kidney injury.