The use of TDF in HBV-HIV-associated infection is associated with kidney and bone problems

TDF is a common component of antiretroviral therapy in adults with hepatitis B and HIV.

Several biomarkers of kidney function and bone turnover indicated her long-term deterioration. Photo: shutterstock.

Patients infected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) taking tenofovir disoproxil fumarate (TDF) May lead to deterioration of kidney function and bone turnoveraccording to a small prospective cohort study in HIV Medicine.

In this group of HBV-HIV adults with a high prevalence of Tenofovir use, different vital signs of kidney function and bone turnover indicates deterioration over approximately 4 years, highlighting the importance of physician awareness,” said senior author Richard K. Stirling, MD.

TDF is a common component of antiretroviral therapy (ART) in adults with hepatitis B and HIV. The drug is known to adversely affect kidney function and bone turnover, but Few studies have evaluated these problems.the authors write.

“It is important to monitor the long-term effects of TDF on Kidney Health and bones,” Stirling advised. for kidney health, Physicians should monitor glomerular filtration rate (GFR), creatinine and bone healthit could be Monitoring blood calciumvitamin D, thyroid hormone, and phosphate are not detected Increased bone turnover“.

“We knew that TDF could impair kidney function; however, we were surprised that we did not see an increase in Important in serum creatininebut We observed a decrease in glomerular filtration rate and different signs Increased bone turnover“.

Study of patients with hepatitis B and HIV

Stirling and colleagues enrolled adults with hepatitis B and HIV who were taking any type of antiretroviral therapy in their study at eight North American sites.

Authors Assessment of demographic data, medical history and current health status reportsexams Physical and blood tests Walpole. They extracted clinical, laboratory, and radiological data from medical records, processed whole blood, and stored serum at -70°C (-94°F) at each site, and Samples analyzed in central laboratories.

The researchers evaluated the participants at the start of the study and Every 24 up to 192 weeks (3.7 years). They analyzed bone markers from stored serum at baseline, week 96, and week 192 and recorded changes in markers of renal function and bone turnover. over time.

At the beginning of the study, The median age of 115 patients was 49 years; 91% were male, of whom 52% were non-Hispanic black. The mean body mass index (BMI) was 26 kg/m2, and 6.3% of participants were underweight and 59% were overweight or obese. participants They have been living with HIV for an average of 20 years.

Overall, 84% of participants reported use of tenofovir, 3% reported no treatment for hepatitis B virus, and 80% experienced suppression of hepatitis B virus/HIV. also, 13% had stage 2 cirrhosis and 23% had stage 3 or 4 cirrhosis. No participants reported use of immunosuppressants, 4% indicated they had used anticoagulants. 3% reported taking calcium in addition to vitamin D and 33% reported taking a multivitamin.

Throughout the follow-up period, TDF use ranged from 80% to 92%. Glomerular filtration rate eGFR decreased from 87.1 to 79.9 mL/min/1.73 m2 over 192 weeks, but prevalence of eGFR <60 mL/min/1.73 m2 did not appear to change over time (always <16%).

Predictors of low eGFR were included Younger age, male gender, overweight or obesity. Predictors of deteriorating bone turnover included black race, healthy weight, advanced fibrosis, undetectable HBV DNA, and low parathyroid hormone levels.

Stirling acknowledged that study limitations include a small group, a short follow-up, and a lack of monitoring of participants who were taking TDF while they were infected with hepatitis B or HIV. He added that strengths include close monitoring, Use markers of bone turnover and monitor severity of liver disease.

Joseph Alvarnas, MD, a hematologist and oncologist in the division of hematology and hematopoietic cell transplantation at City of Hope Comprehensive Cancer Center in Duarte, California, said he welcomes the rigor of the study. “This study provides an important reminder of the complexities of a comprehensive management approach to the long-term care of patients with HIV infection,” Alfanas wrote in an email. He did not participate in the study.

More than 6 million people worldwide live with co-infection“Patients with hepatitis B and HIV infection have additional care needs compared to those living alone with chronic HIV infection,” he added. with More HIV-infected patients become long-term survivors and are treated with effective antiretroviral therapy.A full understanding of the differentiated long-term care needs of this population is critical.”

Debika Bhattacharya, MD, an HIV infection and viral hepatitis specialist in the Division of Infectious Diseases at UCLA Health in Los Angeles, joined forces with Sterling and Alvarnas in advising doctors for regular screening Kidney and bone health of their sick patients.

“While this study focuses on the very common antiretroviral agent TDF, It will be important to see the effect of a similar drug, tenofovir alafenamide (Tav)which was associated with a lower impact on bone and kidney health, on clinical outcomes in patients with hepatitis B. HIV-associated infection,” wrote Bhattacharya, who was also not involved in the study.

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