Treatment of Human Immunodeficiency Virus Infection With Tenofovir Disoproxil Fumarate-Containing Antiretrovirals Maintains Low Bone Formation Rate, But Increases Osteoid Volume on Bone Histomorphometry

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Ramalho, Janaina ^[1] ; Wagner Martins, Carolina Steller ^[1] ; Galvao, Juliana ^[2] ; Furukawa, Luzia N. ^[1] ; Domingues, Wagner V. ^[1] ; Oliveira, Ivone B. ^[1] ; dos Reis, Luciene M. ^[1] ; Pereira, Rosa M. R. ^[3] ; Nickolas, Thomas L. ^[4] ; Yin, Michael T. ^[4] ; Eira, Margareth ^{[5, 6]} ; Jorgetti, Vanda ^{[1, 7]} ; Moyses, Rosa M. A. ^{[1, 2]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Hosp Clin, Dept Nephrol, Lab Invest Med 16, Sao Paulo, SP - Brazil

^[2] Univ Nove Julho, Postgrad Med Dept, Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Fac Med, Div Rheumatol, Bone Lab Metab, Sao Paulo, SP - Brazil

^[4] Columbia Univ, Dept Med, Irving Med Ctr, New York, NY - USA

^[5] Inst Infectol Emilio Ribas, Ambulatory Div, Sao Paulo, SP - Brazil

^[6] Univ Cidade Sao Paulo UNICID, Med Dept, Sao Paulo, SP - Brazil

^[7] Hosp Samaritano Amer Serv Med, Dialysis Div, Sao Paulo, SP - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Journal of Bone and Mineral Research; v. 34, n. 9 JULY 2019.
• Citações Web of Science: 1

Resumo

Bone mineral density (BMD) loss is a known complication of human immunodeficiency virus (HIV) infection and its treatment, particularly with tenofovir disoproxil fumarate (TDF)-containing antiretroviral regimens. Although renal proximal tubular dysfunction and phosphaturia is common with TDF, it is unknown whether BMD loss results from inadequate mineralization. We evaluated change in BMD by dual-energy X-ray absorptiometry (DXA) and bone histomorphometry by tetracycline double-labeled transiliac crest biopsies in young men living with HIV before (n = 20) and 12 months after (n = 16) initiating TDF/lamivudine/efavirenz. We examined relationships between calciotropic hormones, urinary phosphate excretion, pro-inflammatory and pro-resorptive cytokines, and bone remodeling-related proteins with changes in BMD and histomorphometry. Mean age was 29.6 +/- 5.5 years, with mean CD4 + T cell count of 473 +/- 196 cells/mm(3). At baseline, decreased bone formation rate and increased mineralization lag time were identified in 16 (80%) and 12 (60%) patients, respectively. After 12 months, we detected a 2% to 3% decrease in lumbar spine and hip BMD by DXA. By histomorphometry, we observed no change in bone volume/total volume (BV/TV) and trabecular parameters, but rather, increases in cortical thickness, osteoid volume, and osteoblast and osteoclast surfaces. We did not observe significant worsening of renal phosphate excretion or mineralization parameters. Increases in PTH correlated with decreased BMD but not histomorphometric parameters. Overall, these data suggest abnormalities in bone formation and mineralization occur with HIV infection and are evident at early stages. With TDF-containing antiretroviral therapy (ART), there is an increase in bone remodeling, reflected by increased osteoblast and osteoclast surfaces, but a persistence in mineralization defect, resulting in increased osteoid volume. (c) 2019 American Society for Bone and Mineral Research (AU)

• Processo FAPESP: 15/03796-6 - Avaliação óssea histomorfométrica de pacientes com síndrome da imunodeficiência adquirida em tratamento com regime contendo tenofovir
• Beneficiário: Rosa Maria Affonso Moysés
• Modalidade de apoio: Auxílio à Pesquisa - Regular