Mulubwa Mwila, Viljoen Michelle, Kruger Iolanthe M, Kruger Herculina S, Rheeders Malie
Centre of Excellence for Pharmaceutical Sciences (Pharmacen), Division of Pharmacology, North-West University, South Africa.
Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, South Africa.
South Afr J HIV Med. 2017 Dec 6;18(1):739. doi: 10.4102/sajhivmed.v18i1.739. eCollection 2017.
Tenofovir disoproxil fumarate (TDF) antiretroviral therapy is associated with disruption of the bone turnover process.
The objective of this study was to determine the association between tenofovir (TFV) plasma concentration and various bone turnover markers and compare these markers in HIV-infected women and HIV-uninfected controls.
A cross-sectional sub-study included 30 HIV-infected women on TDF and 30 HIV-uninfected matched participants. Serum calcium (SrCa), serum phosphate (SrP), C-terminal telopeptide (CTx), parathyroid hormone (PTH), alkaline phosphatase (ALP), C-reactive protein (CRP), vitamin D (VitD) and bone mineral density (BMD) were measured. Plasma TFV was assayed on HPLC-MS/MS. The statistical tests applied were Mann-Whitney test, unpaired -test, analysis of covariance, regression and correlation analysis.
In HIV-infected women, no correlation existed between plasma TFV concentration and CTx, PTH, ALP, SrCa, SrP, VitD or BMD ( > 0.05). After adjusting for smoking and alcohol use, ALP ( < 0.001), CTx ( = 0.027) and PTH ( = 0.050) were significantly higher in HIV-infected compared to HIV-uninfected women. Women with TFV concentration ≥ 120 ng/mL had higher PTH concentrations ( = 0.037) compared to those with ≤ 100 ng/mL. Significant correlations between SrCa and PTH and SrCa and SrP including CTx and PTH ( < 0.05) were present in HIV-uninfected women while absent in HIV-infected counterparts ( > 0.05).
The results indicate possible increased bone turnover at higher TFV concentrations. The normal regular bone turnover processes in HIV-infected women on TDF therapy are altered. Larger studies are warranted to confirm these results.
替诺福韦酯（TDF）抗逆转录病毒疗法与骨转换过程的破坏有关。
本研究的目的是确定替诺福韦（TFV）血浆浓度与各种骨转换标志物之间的关联，并比较HIV感染女性和未感染HIV的对照者的这些标志物。
一项横断面子研究纳入了30名接受TDF治疗的HIV感染女性和30名匹配的未感染HIV参与者。测量血清钙（SrCa）、血清磷（SrP）、C末端肽（CTx）、甲状旁腺激素（PTH）、碱性磷酸酶（ALP）、C反应蛋白（CRP）、维生素D（VitD）和骨密度（BMD）。采用高效液相色谱-串联质谱法测定血浆TFV。应用的统计检验包括曼-惠特尼检验、非配对t检验、协方差分析、回归分析和相关分析。
在HIV感染女性中，血浆TFV浓度与CTx、PTH、ALP、SrCa、SrP、VitD或BMD之间无相关性（P>0.05）。在调整吸烟和饮酒因素后，与未感染HIV的女性相比，HIV感染女性的ALP（P<0.001）、CTx（P=0.027）和PTH（P=0.050）显著更高。与TFV浓度≤100 ng/mL的女性相比，TFV浓度≥120 ng/mL的女性PTH浓度更高（P=0.037）。未感染HIV的女性中SrCa与PTH、SrCa与SrP以及CTx与PTH之间存在显著相关性（P<0.05），而在感染HIV的女性中不存在这些相关性（P>0.05）。
结果表明在较高TFV浓度下可能存在骨转换增加。接受TDF治疗的HIV感染女性正常的骨转换过程发生了改变。需要更大规模的研究来证实这些结果。
