替诺福韦与骨骼健康。
Tenofovir and bone health.
作者信息
Grant Philip M, Cotter Aoife G
机构信息
aDivision of Infectious Diseases; Department of Medicine; Stanford University, Palo Alto, CA, USA bHIV Molecular Research Group, School of Medicine & Medical Science, University College Dublin cDepartment of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
出版信息
Curr Opin HIV AIDS. 2016 May;11(3):326-32. doi: 10.1097/COH.0000000000000248.
Abstract
PURPOSE OF REVIEW
With continued improvements to the antiviral efficacy and tolerability of antiretroviral therapy, long-term safety of antiretroviral therapy has become paramount. Low bone mineral density and fragility fractures are more common in HIV-infected individuals than in the general population. The aims of this review are to describe potential mechanisms underlying the adverse effects of tenofovir on bone, clinical studies of tenofovir disoproxil fumarate (TDF) and bone, and more recent bone data on tenofovir alafenamide.
RECENT FINDING
Several studies have demonstrated an approximately 1-3% greater bone mineral density loss with TDF compared with other agents. Recent studies with tenofovir alafenamide have shown improved bone (and renal) safety with similar virologic efficacy when compared to TDF.
SUMMARY
Given these findings, TDF-containing regimens may be gradually replaced with non-TDF containing regimens for the treatment of HIV infection, especially in those at higher risk for fragility fracture.
摘要
综述目的
随着抗逆转录病毒疗法的抗病毒疗效和耐受性不断提高，抗逆转录病毒疗法的长期安全性已变得至关重要。与普通人群相比，HIV感染者的低骨矿物质密度和脆性骨折更为常见。本综述的目的是描述替诺福韦对骨骼产生不良反应的潜在机制、富马酸替诺福韦二吡呋酯（TDF）与骨骼的临床研究，以及关于丙酚替诺福韦的最新骨骼数据。
最新发现
多项研究表明，与其他药物相比，TDF导致的骨矿物质密度损失大约高1%-3%。与TDF相比，近期关于丙酚替诺福韦的研究显示，在病毒学疗效相似的情况下，骨骼（和肾脏）安全性有所改善。
总结
鉴于这些发现，含TDF的治疗方案可能会逐渐被不含TDF的方案所取代，用于治疗HIV感染，尤其是在脆性骨折风险较高的人群中。
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