INTRODUCTION
Tenofovir Disoproxil Fumarate (TDF) is one of the newest and more tolerable backbone of highly active antiretroviral therapy (HAART) in the class of nucleotide reverse transcriptase inhibitor (NRTI). In 2016, World Health Organization (WHO) published a consolidated guideline that recommended Tenofovir based regimen as the first line for adults and adolescents and henceforward this regimen has been extensively rolled out11ReferencesWHO (2018, January 1). Updated recommendations on the first line and second line antiretroviral regimens and post exposure prophylaxis and recommendations on early infant diagnosis of HIV. Despite its excellent safety profile and tolerability TDF is known to cause proximal tubule renal dysfunction. TDF renal tubulopathy can manifest as Fanconi syndrome (FS), Acute kidney injury or chronic kidney disease22Verhelst D,  Monge M, MeynardJL, et al. Fanconi syndrome and renal failure induced by tenofovir: a first case report, Am J Kidney Dis , 2002, vol. 40(pg. 13313). Here, we present the case of a middle age African female on Tenofovir based regimen who developed Fanconi syndrome after 12 years of Tenofovir based HAART.