Tenofovir Dosage Guidelines for HIV-Infected Adults and Adolescents

Standard Dosing for HIV Treatment

The standard dose of tenofovir disoproxil fumarate (TDF) for HIV treatment in adults and adolescents with normal kidney function is 300 mg orally once daily, with no dosage adjustment required, as recommended by the Clinical Infectious Diseases guidelines 1, 2
No adjustment is needed for normal renal function, defined as creatinine clearance ≥50 mL/min, according to the Clinical Infectious Diseases guidelines 1, 2

For patients with creatinine clearance 30-49 mL/min, the recommended dose is 300 mg every 48 hours, as per the Clinical Infectious Diseases guidelines 1, 2
For patients with creatinine clearance 10-29 mL/min, the recommended dose is 300 mg every 72-96 hours, according to the Clinical Infectious Diseases guidelines 1, 2
For hemodialysis patients, the recommended dose is 300 mg every 7 days after dialysis session, as recommended by the Clinical Infectious Diseases guidelines 1, 2
No adjustment is needed for hepatic impairment of any severity, as stated in the Clinical Infectious Diseases guidelines 1

Renal function monitoring is essential even with normal baseline function, as tenofovir can cause progressive nephrotoxicity, according to the Clinical Infectious Diseases guidelines 4, 5
Creatinine clearance should be checked at baseline, 2-4 weeks after initiation, and then every 3-6 months, as recommended by the Clinical Infectious Diseases guidelines 5
More frequent monitoring (every 1-2 weeks) is required if risk factors are present, such as baseline renal dysfunction, concurrent nephrotoxic drugs, or advanced HIV disease, according to the Clinical Infectious Diseases guidelines 5

Didanosine requires dose reduction due to increased didanosine exposure when co-administered with tenofovir, as stated in the Praxis Medical Insights guidelines 3
Atazanavir clearance decreases by 23.5% when used with atazanavir/ritonavir, though standard tenofovir dosing is typically maintained with enhanced monitoring, according to the Praxis Medical Insights guidelines 3

Tenofovir alafenamide 25 mg (as part of combination products) once daily is an alternative that achieves similar efficacy with lower systemic tenofovir exposure, as recommended by the Praxis Medical Insights guidelines 3, 6
TAF is preferred over TDF for patients with creatinine clearance 30-60 mL/min, osteopenia or osteoporosis, or concerns about long-term bone or renal toxicity, according to the Praxis Medical Insights guidelines 3, 6