Sudjaritruk Tavitiya, Bunupuradah Torsak, Aurpibul Linda, Kosalaraksa Pope, Kurniati Nia, Sophonphan Jiratchaya, Ananworanich Jintanat, Puthanakit Thanyawee
Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
Antivir Ther. 2017;22(6):471-479. doi: 10.3851/IMP3103. Epub 2016 Oct 27.
This study aimed to determine the effect of tenofovir disoproxil fumarate (TDF) on bone metabolism and bone mass in HIV-infected adolescents.
This was a sub-study of a cross-sectional multicentre bone health trial that enrolled perinatally HIV-infected Thai and Indonesian adolescents (10-18 years) with viral suppression on antiretroviral therapy. Participants were classified into two groups as TDF users and non-users. Bone metabolism-related markers (25-hydroxyvitamin D [25-OHD], intact parathyroid hormone [iPTH], bone turnover biomarkers), and lumbar spine dual-energy X-ray absorptiometry were assessed. Bone mineral density (BMD)/bone mineral apparent density (BMAD) Z-scores were calculated.
Of 394 adolescents, 136 (34.5%) and 258 (65.5%) were TDF users and non-users, respectively. Among TDF users, median age (IQR) was 16.1 (14.7-17.4) years and TDF treatment duration (IQR) was 2.3 (1.4-3.1) years. Among TDF non-users, median age (IQR) was 14.3 (12.6-16.4) years. BMD and BMAD Z-scores comparing TDF users with non-users were -0.8 and -0.6 (P=0.27), and -0.3 and -0.2 (P=0.58), respectively. The association between TDF use and iPTH elevation was intensified in adolescents with suboptimal vitamin D levels (25-OHD <30 ng/ml; P=0.001). TDF administration was positively associated with bone resorption marker (P=0.04) and negatively associated with bone formation marker (P=0.04). With data up to 4 years, neither association between TDF use and bone mass loss (BMD: P=0.09; BMAD: P=0.22), nor variation of bone mass Z-scores by TDF treatment duration (BMD: P=0.34; BMAD: P=0.58) was demonstrated.
Recent TDF administration was correlated with PTH elevation and bone turnover dysregulation but not with bone mass reduction in our cohort. A study with extended follow-up to ascertain TDF-associated bone mass deterioration is warranted.
本研究旨在确定富马酸替诺福韦二吡呋酯（TDF）对感染HIV的青少年骨代谢和骨量的影响。
这是一项横断面多中心骨健康试验的子研究，该试验纳入了在接受抗逆转录病毒治疗后病毒得到抑制的围产期感染HIV的泰国和印度尼西亚青少年（10 - 18岁）。参与者被分为两组，即TDF使用者和非使用者。评估了骨代谢相关标志物（25 - 羟基维生素D [25 - OHD]、完整甲状旁腺激素 [iPTH]、骨转换生物标志物）以及腰椎双能X线吸收测定法。计算了骨矿物质密度（BMD）/骨矿物质表观密度（BMAD）Z评分。
在394名青少年中，分别有136名（34.5%）为TDF使用者，258名（65.5%）为非使用者。在TDF使用者中，中位年龄（四分位间距）为16.1（14.7 - 17.4）岁，TDF治疗持续时间（四分位间距）为2.3（1.4 - 3.1）年。在非TDF使用者中，中位年龄（四分位间距）为14.3（12.6 - 16.4）岁。将TDF使用者与非使用者进行比较，BMD和BMAD Z评分分别为 - 0.8和 - 0.6（P = 0.27），以及 - 0.3和 - 0.2（P = 0.58）。在维生素D水平未达最佳（25 - OHD < 30 ng/ml）的青少年中，使用TDF与iPTH升高之间的关联增强（P = 0.001）。TDF给药与骨吸收标志物呈正相关（P = 0.04），与骨形成标志物呈负相关（P = 0.04）。在长达4年的数据中，未显示TDF使用与骨量丢失之间的关联（BMD：P = 0.09；BMAD：P = 0.22），也未显示骨量Z评分随TDF治疗持续时间的变化（BMD：P = 0.34；BMAD：P = 0.58）。
在我们的队列中，近期使用TDF与PTH升高和骨转换失调相关，但与骨量减少无关。有必要进行一项延长随访的研究，以确定与TDF相关的骨量恶化情况。
