BONE HISTOMORPHOMETRIC EVALUATION OF PATIENTS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME IN TREATMENT WITH REGIMEN TENOFOVIR

• Grant number: 15/03796-6
• Support type: Regular Research Grants
• Duration: September 01, 2015 - February 28, 2018
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal researcher: Rosa Maria Affonso Moysés
• Grantee: Rosa Maria Affonso Moysés
• Home Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Assoc. researchers: Fabiana Giorgeti Graciolli ; Janaina de Almeida Mota Ramalho ; Luciene Machado dos Reis ; Rosa Maria Rodrigues Pereira ; Vanda Jorgetti

Abstract

Introduction: The reduction in bone mineral density (BMD) is a known metabolic complication of HIV infection and its treatment, with a 2-6% loss of bone mass being observed after initiation of antiretroviral therapy (ART). Some antiretrovirals, especially tenofovir (TDF), are associated with greater bone loss. The reduction in BMD observed in dual energy x-ray absorptiometry (DXA) may reflect both a decrease in bone volume with changes in bone microarchitecture, characteristic of osteoporosis, and impaired bone mineralization or subclinical osteomalacia, conditions that require different therapeutic approaches. The mechanisms involved in the reduction in BMD after initiation of HAART and the differences in the means by which each class of drugs induces bone loss are unclear. One of the possible mechanisms implicated in bone loss induced by the TDF is impaired bone mineralization by proximal tubular dysfunction, with acidosis, excessive phosphaturia and hypophosphatemia, and decreased 1,25 (OH) 2-vitamin D production associated with the medication. Objectives: To evaluate the effects of initiation of HAART regimen including tenofovir on histomorphometric markers of bone mineralization. To evaluate bone structure, formation and resorption parameters as well as bone mineral density in treatment-naïve patients with HIV / AIDS before and one year after TDF. Material and Methods: 25 treatment-naïve patients with HIV will be selected to iniate HAART with Tenofovir, Lamivudine and Efavirenz. Patients will undergo bone biopsy of the iliac crest with double tetracycline labeling before start of treatment and 1 year later. BMD measurement by DXA and bone microarchitecture by peripheral quantitative computed tomography high-resolution (HRpQCT) will be held before the start of treatment, 6 months and 12 months after ART initiation. Blood and urine samples will be collected for laboratory evaluation of markers related to bone and mineral metabolism and to the status of HIV infection. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

RAMALHO, JANAINA; WAGNER MARTINS, CAROLINA STELLER; GALVAO, JULIANA; FURUKAWA, LUZIA N.; DOMINGUES, WAGNER V.; OLIVEIRA, IVONE B.; DOS REIS, LUCIENE M.; PEREIRA, ROSA M. R.; NICKOLAS, THOMAS L.; YIN, MICHAEL T.; EIRA, MARGARETH; JORGETTI, VANDA; MOYSES, ROSA M. A. Treatment of Human Immunodeficiency Virus Infection With Tenofovir Disoproxil Fumarate-Containing Antiretrovirals Maintains Low Bone Formation Rate, But Increases Osteoid Volume on Bone Histomorphometry. Journal of Bone and Mineral Research, v. 34, n. 9 JULY 2019. Web of Science Citations: 1.