Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
PLoS One. 2012;7(9):e44845. doi: 10.1371/journal.pone.0044845. Epub 2012 Sep 12.
Tenofovir has been associated with renal phosphate wasting, reduced bone mineral density, and higher parathyroid hormone levels. The aim of this study was to carry out a detailed comparison of the effects of tenofovir versus non-tenofovir use on calcium, phosphate and, vitamin D, parathyroid hormone (PTH), and bone mineral density.
A cohort study of 56 HIV-1 infected adults at a single centre in the UK on stable antiretroviral regimes comparing biochemical and bone mineral density parameters between patients receiving either tenofovir or another nucleoside reverse transcriptase inhibitor.
In the unadjusted analysis, there was no significant difference between the two groups in PTH levels (tenofovir mean 5.9 pmol/L, 95% confidence intervals 5.0 to 6.8, versus non-tenofovir; 5.9, 4.9 to 6.9; p = 0.98). Patients on tenofovir had significantly reduced urinary calcium excretion (median 3.01 mmol/24 hours) compared to non-tenofovir users (4.56; p<0.0001). Stratification of the analysis by age and ethnicity revealed that non-white men but not women, on tenofovir had higher PTH levels than non-white men not on tenofovir (mean difference 3.1 pmol/L, 95% CI 5.3 to 0.9; p = 0.007). Those patients with optimal 25-hydroxyvitamin D (>75 nmol/L) on tenofovir had higher 1,25-dihydroxyvitamin D [1,25(OH)(2)D] (median 48 pg/mL versus 31; p = 0.012), fractional excretion of phosphate (median 26.1%, versus 14.6; p = 0.025) and lower serum phosphate (median 0.79 mmol/L versus 1.02; p = 0.040) than those not taking tenofovir.
The effects of tenofovir on PTH levels were modified by sex and ethnicity in this cohort. Vitamin D status also modified the effects of tenofovir on serum concentrations of 1,25(OH)(2)D and phosphate.
替诺福韦与肾磷酸盐丢失、骨密度降低和甲状旁腺激素水平升高有关。本研究的目的是详细比较替诺福韦与非替诺福韦使用对钙、磷酸盐和维生素 D、甲状旁腺激素（PTH）和骨密度的影响。
在英国的一个单一中心对 56 名 HIV-1 感染成人进行的队列研究，比较了接受替诺福韦或另一种核苷逆转录酶抑制剂治疗的患者之间的生化和骨密度参数。
在未调整的分析中，两组之间的 PTH 水平无显著差异（替诺福韦组平均 5.9 pmol/L，95%置信区间 5.0 至 6.8，而非替诺福韦组为 5.9，4.9 至 6.9；p = 0.98）。与非替诺福韦使用者相比，接受替诺福韦治疗的患者尿钙排泄量显著减少（中位数 3.01mmol/24 小时）（p<0.0001）。通过年龄和种族进行分析分层显示，非白人男性而非女性，接受替诺福韦治疗的患者的 PTH 水平高于未接受替诺福韦治疗的非白人男性（平均差异 3.1 pmol/L，95%置信区间 5.3 至 0.9；p = 0.007）。接受替诺福韦治疗且 25-羟维生素 D 水平最佳（>75 nmol/L）的患者，其 1,25-二羟维生素 D [1,25(OH)(2)D]水平较高（中位数 48 pg/mL 比 31；p = 0.012），磷酸盐分数排泄率较高（中位数 26.1%比 14.6%；p = 0.025），血清磷酸盐水平较低（中位数 0.79 mmol/L 比 1.02；p = 0.040）。
在本队列中，替诺福韦对 PTH 水平的影响受到性别和种族的影响。维生素 D 状态也调节了替诺福韦对血清 1,25(OH)(2)D 和磷酸盐浓度的影响。
