Evaluation of the effects of tenofovir on bone mineral density in patients with chronic hepatitis B not infected with HIV

Author(s)

Renata Dessordi

• Document type: Doctoral Thesis
• Press: Araraquara. 2019-07-25.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Ciências Farmacêuticas. Araraquara
• Defense date: 2019-07-04
• Advisor: Anderson Marliere Navarro

Abstract

Hepatitis B is one the most important public health problem worldwide and is associated with considerably high mortality rates. Oral medications, generally nucleoside/nucleotide analogs such as tenofovir, have been used as long-term therapy and have possible side effects such as the reduction in bone mineral density associated with their use. Objective: to evaluate the effects of tenofovir, compared with those of other nucleoside/nucleotide analogs (entecavir and lamivudine), on the bone mineral density of hepatitis B patients. Materials and Methods: a cross-sectional study was conducted with 81 adult patients with chronic hepatitis B treated. The average age of the participants was 42 years. Dual-energy x-ray absorptiometry (DXA) was performed to assess bone mineral density. Biochemical analyses were performed for osteocalcin, deoxypyridinoline, parathyroid hormone, vitamin D, IGF-1, TSH, testosterone, estradiol, FSH, transaminases, urea, creatinine, calcium, serum and urinary phosphorus, magnesium, FGF-23 and anthropometric measures of weight, height, and body mass index were performed. Participants, both gender, were divided according to the use of antiretrovirals: Group 1: 27 inactive virus carriers without medication; Group 2: 27 patients using tenofovir; Group 3: 27 patients using lamivudine or entecavir. Results: We did not find differences in mean age, body mass index, lean and fat mass between patients in both groups (p>0.05). DXA readings diagnosed osteopenia in the lumbar spine for 7.4% individuals in Group 1, 15% in Group 2 and 3.7% in Group 3. For all groups we observed normal values in bone formation markers, osteocalcin levels as well as parathyroid hormone, insulin growth factor 1 and FGF-23. In all groups, we found increased levels of urinary deoxypyridinoline, a bone resorption marker. Normal levels of calcium, phosphorus (serum and urine) and magnesium were observed. Conclusion: Increased levels in the bone resorption markers indicated a high resorptive activity of bone tissue. These data emphasized a greater osteoclastic activity that led to bone loss in hepatitis B virus-infected patients both treated or not with antiretrovirals. (AU)

• FAPESP's process: 16/19284-7 - Assessment of Tenofovir effects on bone mineral density in chronic Hepatitis B patients non infected with HIV
• Grantee: Renata Dessordi
• Support Opportunities: Scholarships in Brazil - Doctorate