Tenofovir disoproxil fumarate and bone mineral density: a 60-month longitudinal study in a cohort of HIV-infected youths

Pediatric Infectious Diseases Unit, Department of Pediatrics, L Sacco Hospital, University of Milan, Milan, Italy.
Antiviral therapy (Impact Factor: 3.02). 01/2010; 15(7):1053-8.
Source: PubMed


Decreased bone mineral density (BMD) has been associated with the use of tenofovir disoproxil fumarate (TDF) in HIV-infected adults. The data in HIV-infected children are conflicting. The aim of this study was to assess the safety of a TDF-containing antiretroviral (ARV) regimen on BMD in paediatric patients. We report the results of a longitudinal 60-month follow-up study.
A total of 21 vertically HIV-infected Caucasian youths (10 male and 11 female) on ARV treatment containing lamivudine, efavirenz and TDF were enrolled (age range 4.9-17.9 years at baseline). BMD was measured at the lumbar spine and in the whole skeleton by DXA. Bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker and urinary N-telopeptide of type-I collagen (NTx) was measured as a bone resorption index.
Baseline mean (±sd) BMD measurements of HIV-infected patients expressed as z-scores were -0.7 (±0.9) for lumbar spine and -0.13 (±1.0) for the whole skeleton. BMD measurements did not change significantly during the 60-month observation period. Both BAP and NTx concentrations were higher than a reference group of controls at baseline and remained unchanged throughout the study.
Our data indicate that a TDF-containing regimen does not decrease the BMD of HIV-infected youths.

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    • "In 16 Italian children (6–18 years) receiving suppressive ART regimens, replacing stavudine and PI with tenofovir and efavirenz did not result in smaller 12-month BMC or BMD increases relative to HIV-uninfected peers [49]. Another study of 21 Italian children receiving tenofovir/efavirenz/lamivudine documented no significant change in BMD Z-score from baseline through 60 months [50]. The lack of a negative effect on BMD observed in these studies may be explained by the use of a lower dose of tenofovir, lack of concomitant PIs and ART switch (instead of ART initiation). "
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