TY - JOUR
T1 - Effects of renal tubular dysfunction on bone in tenofovir-exposed HIV-positive patients
AU - Hamzah, Lisa
AU - Samarawickrama, Amanda
AU - Campbell, Lucy
AU - Pope, Matthew
AU - Burling, Keith
AU - Walker-Bone, Karen
AU - Gilleece, Yvonne
AU - Fisher, Martin
AU - Post, Frank A.
PY - 2015/9/10
Y1 - 2015/9/10
N2 - Objectives: Tenofovir disoproxil fumarate (TDF) may cause renal tubular dysfunction (RTD) and reduce bone mineral density (BMD). We examined the relationship between RTD and BMD in TDF-exposed HIV-positive men. Design and methods: We analysed urinary retinol-binding protein/creatinine ratio (RBPCR) and fractional excretion of phosphate (FEPO4) to quantify RTD in a crosssectional sample of randomly selected HIV-positive men at a single tertiary outpatient clinic. BMD at the lumbar spine and hip was measured by dual-energy X-ray absorptiometry. Multivariate logistic regression was used to analyse factors associated with RTD, and linear regression to examine the relationship between RTD and BMD. Results: Of 293 men (mean age 48 years, 94% White ethnicity, median TDF exposure 2.1 years), 22.5% had RBPCR-defined RTD and 12.3% had FEPO4-defined RTD. We observed a negative correlation between RBPCR and BMD at the spine (β -0.2, P=0.002) and hip (total: β -0.1, P=0.02; femoral neck: β -0.1, P=0.02), but not between FePO4 and BMD. In multivariable analyses, RTD defined by more than fivefold elevations in RBPCR was associated with significantly lower BMD of the spine. Conclusion: In HIV-positive patients receiving TDF-containing antiretroviral therapy, RTD was associated with lower BMD of the spine in HIV-positive men. RBPCR quantification may identify patients at increased risk of TDF-associated BMD loss.
AB - Objectives: Tenofovir disoproxil fumarate (TDF) may cause renal tubular dysfunction (RTD) and reduce bone mineral density (BMD). We examined the relationship between RTD and BMD in TDF-exposed HIV-positive men. Design and methods: We analysed urinary retinol-binding protein/creatinine ratio (RBPCR) and fractional excretion of phosphate (FEPO4) to quantify RTD in a crosssectional sample of randomly selected HIV-positive men at a single tertiary outpatient clinic. BMD at the lumbar spine and hip was measured by dual-energy X-ray absorptiometry. Multivariate logistic regression was used to analyse factors associated with RTD, and linear regression to examine the relationship between RTD and BMD. Results: Of 293 men (mean age 48 years, 94% White ethnicity, median TDF exposure 2.1 years), 22.5% had RBPCR-defined RTD and 12.3% had FEPO4-defined RTD. We observed a negative correlation between RBPCR and BMD at the spine (β -0.2, P=0.002) and hip (total: β -0.1, P=0.02; femoral neck: β -0.1, P=0.02), but not between FePO4 and BMD. In multivariable analyses, RTD defined by more than fivefold elevations in RBPCR was associated with significantly lower BMD of the spine. Conclusion: In HIV-positive patients receiving TDF-containing antiretroviral therapy, RTD was associated with lower BMD of the spine in HIV-positive men. RBPCR quantification may identify patients at increased risk of TDF-associated BMD loss.
KW - Bone mineral density
KW - HIV
KW - Renal tubular dysfunction
KW - Tenofovir
UR - http://www.scopus.com/inward/record.url?scp=84988735707&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000000760
DO - 10.1097/QAD.0000000000000760
M3 - Article
AN - SCOPUS:84988735707
SN - 0269-9370
VL - 29
SP - 1785
EP - 1792
JO - Aids
JF - Aids
IS - 14
ER -
