Tubular toxicity as a result of tenofovir exposure is frequently reported; however, these reports are controversial.22 Glomerular damage may occur as a result of factors such as diabetes, hypertension, MetS and HIV infection which then alter permeability to macromolecules such as albumin and other proteins.41,42 In this study, we did not screen the HIV-infected participants for proteinuria, which might have shed some insights into whether the elevated albumin excretion is because of glomerular damage or tubular toxicity. Here, ALB is linked to metabolic syndrome.