A 52-year-old man with HIV and chronic kidney disease (eGFR 28 mL/min/1.73 m²) requires ART. Which NRTI backbone is preferred to minimize nephrotoxicity in this patient?

• A Abacavir plus lamivudine ✓
• B Tenofovir disoproxil fumarate plus emtricitabine
• C Tenofovir alafenamide plus emtricitabine
• D Zidovudine plus lamivudine

Explanation

Tenofovir (both TDF and TAF) is renally cleared and requires dose adjustment or avoidance in severe renal impairment. Abacavir plus lamivudine is the preferred NRTI backbone when tenofovir must be avoided due to renal disease. Abacavir is hepatically metabolized and safe in renal failure after HLA-B*5701 screening. Zidovudine plus lamivudine is an alternative but less preferred due to anemia risk.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.