Bone mineral density reductions after tenofovir disoproxil fumarate initiation and changes in phosphaturia

A secondary analysis of ACTG A5224s

Samir Gupta, Eunice Yeh, Douglas W. Kitch, Todd T. Brown, Charles S. Venuto, Gene D. Morse, Belinda Ha, Kathleen Melbourne, Grace A. McComsey

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: It is unknown if the greater reductions in bone mineral density (BMD) associated with initiation of tenofovir disoproxil fumarate compared with abacavir in previously untreated HIV-infected participants in the ACTG A5224s clinical trial were associated with potentially worsening tenofovir-related phosphaturia. Methods: We correlated changes in BMD at the hip and spine with changes in phosphaturia [transtubular reabsorption of phosphorus (TRP) and tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR)] from entry through week 96 in those initiating tenofovir (n=134) versus abacavir (n=135) with efavirenz or atazanavir/ritonavir in A5224s. We also correlated changes in BMD with tenofovir AUC measured between weeks 4 and 24. Results: Changes in TRP and TmP/GFR through week 96 between the tenofovir and abacavir arms were not significantly different (both P≥0.70) and did not differ with use of efavirenz versus atazanavir/ritonavir. There were no significant correlations between changes in either TRP or TmP/GFR and with either hip or spine BMD in the tenofovir arms. Tenofovir AUC was significantly correlated with changes in hip BMD, but not spine BMD, at week 24 (r=-0.22, P=0.028) and week 48 (r=-0.26, P=0.010), but not at week 96 (r=-0.14, P=0.18). Conclusions: Changes in phosphaturia were not different between the tenofovir and abacavir arms in A5224s. Changes in hip and spine BMD with tenofovir were not related to changes in phosphaturia. However, tenofovir exposure was weakly associated with changes in hip BMD through week 48.

Original languageEnglish (US)
Article numberdkx076
Pages (from-to)2042-2048
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume72
Issue number7
DOIs
StatePublished - Jul 1 2017

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Tenofovir
Familial Hypophosphatemia
Bone Density
efavirenz
Pelvic Bones
Spine
Glomerular Filtration Rate
Phosphorus
Ritonavir
Arm
Phosphates
Area Under Curve
Hip

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Bone mineral density reductions after tenofovir disoproxil fumarate initiation and changes in phosphaturia : A secondary analysis of ACTG A5224s. / Gupta, Samir; Yeh, Eunice; Kitch, Douglas W.; Brown, Todd T.; Venuto, Charles S.; Morse, Gene D.; Ha, Belinda; Melbourne, Kathleen; McComsey, Grace A.

In: Journal of Antimicrobial Chemotherapy, Vol. 72, No. 7, dkx076, 01.07.2017, p. 2042-2048.

Research output: Contribution to journalArticle

Gupta, Samir ; Yeh, Eunice ; Kitch, Douglas W. ; Brown, Todd T. ; Venuto, Charles S. ; Morse, Gene D. ; Ha, Belinda ; Melbourne, Kathleen ; McComsey, Grace A. / Bone mineral density reductions after tenofovir disoproxil fumarate initiation and changes in phosphaturia : A secondary analysis of ACTG A5224s. In: Journal of Antimicrobial Chemotherapy. 2017 ; Vol. 72, No. 7. pp. 2042-2048.
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abstract = "Background: It is unknown if the greater reductions in bone mineral density (BMD) associated with initiation of tenofovir disoproxil fumarate compared with abacavir in previously untreated HIV-infected participants in the ACTG A5224s clinical trial were associated with potentially worsening tenofovir-related phosphaturia. Methods: We correlated changes in BMD at the hip and spine with changes in phosphaturia [transtubular reabsorption of phosphorus (TRP) and tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR)] from entry through week 96 in those initiating tenofovir (n=134) versus abacavir (n=135) with efavirenz or atazanavir/ritonavir in A5224s. We also correlated changes in BMD with tenofovir AUC measured between weeks 4 and 24. Results: Changes in TRP and TmP/GFR through week 96 between the tenofovir and abacavir arms were not significantly different (both P≥0.70) and did not differ with use of efavirenz versus atazanavir/ritonavir. There were no significant correlations between changes in either TRP or TmP/GFR and with either hip or spine BMD in the tenofovir arms. Tenofovir AUC was significantly correlated with changes in hip BMD, but not spine BMD, at week 24 (r=-0.22, P=0.028) and week 48 (r=-0.26, P=0.010), but not at week 96 (r=-0.14, P=0.18). Conclusions: Changes in phosphaturia were not different between the tenofovir and abacavir arms in A5224s. Changes in hip and spine BMD with tenofovir were not related to changes in phosphaturia. However, tenofovir exposure was weakly associated with changes in hip BMD through week 48.",
author = "Samir Gupta and Eunice Yeh and Kitch, {Douglas W.} and Brown, {Todd T.} and Venuto, {Charles S.} and Morse, {Gene D.} and Belinda Ha and Kathleen Melbourne and McComsey, {Grace A.}",
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T1 - Bone mineral density reductions after tenofovir disoproxil fumarate initiation and changes in phosphaturia

T2 - A secondary analysis of ACTG A5224s

AU - Gupta, Samir

AU - Yeh, Eunice

AU - Kitch, Douglas W.

AU - Brown, Todd T.

AU - Venuto, Charles S.

AU - Morse, Gene D.

AU - Ha, Belinda

AU - Melbourne, Kathleen

AU - McComsey, Grace A.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background: It is unknown if the greater reductions in bone mineral density (BMD) associated with initiation of tenofovir disoproxil fumarate compared with abacavir in previously untreated HIV-infected participants in the ACTG A5224s clinical trial were associated with potentially worsening tenofovir-related phosphaturia. Methods: We correlated changes in BMD at the hip and spine with changes in phosphaturia [transtubular reabsorption of phosphorus (TRP) and tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR)] from entry through week 96 in those initiating tenofovir (n=134) versus abacavir (n=135) with efavirenz or atazanavir/ritonavir in A5224s. We also correlated changes in BMD with tenofovir AUC measured between weeks 4 and 24. Results: Changes in TRP and TmP/GFR through week 96 between the tenofovir and abacavir arms were not significantly different (both P≥0.70) and did not differ with use of efavirenz versus atazanavir/ritonavir. There were no significant correlations between changes in either TRP or TmP/GFR and with either hip or spine BMD in the tenofovir arms. Tenofovir AUC was significantly correlated with changes in hip BMD, but not spine BMD, at week 24 (r=-0.22, P=0.028) and week 48 (r=-0.26, P=0.010), but not at week 96 (r=-0.14, P=0.18). Conclusions: Changes in phosphaturia were not different between the tenofovir and abacavir arms in A5224s. Changes in hip and spine BMD with tenofovir were not related to changes in phosphaturia. However, tenofovir exposure was weakly associated with changes in hip BMD through week 48.

AB - Background: It is unknown if the greater reductions in bone mineral density (BMD) associated with initiation of tenofovir disoproxil fumarate compared with abacavir in previously untreated HIV-infected participants in the ACTG A5224s clinical trial were associated with potentially worsening tenofovir-related phosphaturia. Methods: We correlated changes in BMD at the hip and spine with changes in phosphaturia [transtubular reabsorption of phosphorus (TRP) and tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR)] from entry through week 96 in those initiating tenofovir (n=134) versus abacavir (n=135) with efavirenz or atazanavir/ritonavir in A5224s. We also correlated changes in BMD with tenofovir AUC measured between weeks 4 and 24. Results: Changes in TRP and TmP/GFR through week 96 between the tenofovir and abacavir arms were not significantly different (both P≥0.70) and did not differ with use of efavirenz versus atazanavir/ritonavir. There were no significant correlations between changes in either TRP or TmP/GFR and with either hip or spine BMD in the tenofovir arms. Tenofovir AUC was significantly correlated with changes in hip BMD, but not spine BMD, at week 24 (r=-0.22, P=0.028) and week 48 (r=-0.26, P=0.010), but not at week 96 (r=-0.14, P=0.18). Conclusions: Changes in phosphaturia were not different between the tenofovir and abacavir arms in A5224s. Changes in hip and spine BMD with tenofovir were not related to changes in phosphaturia. However, tenofovir exposure was weakly associated with changes in hip BMD through week 48.

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