Fanconi Syndrome Leading to Hypophosphatemic Osteomalacia Related to Tenofovir Use

Round 1

Reviewer 1 Report

The paper reports a case study of a patient with HIV who developed TDF-related Fanconi syndrome with associated hypophosphatemia and osteomalacia. The paper was well-written and easy to read. Even though the observations reported in the paper cannot be generalized to a greater population, they will certainly be of interest to readers. I have no major concerns but have small editorial comments.

• Please include a consent statement in Section 2 as well.
• Line 15: No need to use the abbreviation for PO4 as it is not used again.
• Line 15: Space needed in “calcitriol.With”
• Line 21: Define HIV.
• Line 22: Define ART (which was later defined in Line 24)
• Line 25: Define TDF
• Line 31: (HBV >> (HBV)
• Line 32: Thus >> Thus,
• Line 61: Define RTA (which was later defined in Line 157)
• Line 69: Define HLA
• Line 88: protease inhibitor use (PI) >> protease inhibitor (PI) use
• Line 88: eg >> e.g.
• Line 110: PTH was defined earlier.
• Figure 2: Relate the caption with the panels in the figure by adding figure labels.
• Figure 2 Caption: Bone Scan >> Bone scan

Author Response

• Please include a consent statement in Section 2 as well : included in section 2, line 78. 
• Line 15: No need to use the abbreviation for PO4 as it is not used again: abbreviation deleted. 
• Line 15: Space needed in “calcitriol.With”: Space inserted. 
• Line 21: Define HIV.: Defined HIV
• Line 22: Define ART (which was later defined in Line 24): Defined ART
• Line 25: Define TDF: Defined TDF
• Line 31: (HBV >> (HBV): Rectified
• Line 32: Thus >> Thus,: Rectified
• Line 61: Define RTA (which was later defined in Line 157)" Defined RTA
• Line 69: Define HLA: Defined HLA
• Line 88: protease inhibitor use (PI) >> protease inhibitor (PI) use: change made
• Line 88: eg >> e.g.: rectified
• Line 110: PTH was defined earlier.: Omitted 
• Figure 2: Relate the caption with the panels in the figure by adding figure labels.: Done
• Figure 2 Caption: Bone Scan >> Bone scan: Rectified

Author Response File: Author Response.docx

Reviewer 2 Report

This is a very interesting and sound work. However, the relationship between Fanconi syndrome, Osteomalacia and Hypophosphatemia must be more explicitly and comprehensively stated in the Conclusion. May Fanconi syndrome appear without any kind of Osteomalacia? Does hypophosphatemia necessarily imply Osteomalacia? Please rewrite the Conclusion in order to make these extremes more clear to the reader.

Author Response

May Fanconi syndrome appear without any kind of Osteomalacia? Does hypophosphatemia necessarily imply Osteomalacia? Please rewrite the Conclusion in order to make these extremes more clear to the reader.

Response:

Conclusion rewritten with the addition of the statement "These clinical entities may also occur independently as a result of long term TDF use." Line 161, 162. 

Author Response File: Author Response.docx