Antiretroviral therapy linked with subclinical renal dysfunction, bone loss in young patients with HIV

Young adults with HIV showed subclinical markers of renal dysfunction associated with tenofovir exposure, while exposures to didanosine and stavudine were linked with lower BMD, study data show.

“Early in the HIV epidemic, chronic kidney disease was seen in children and adults with HIV, most commonly due to HIV-associated nephropathy,” Aylin B. Unsal, BS, of the laboratory of immunoregulation at the National Institute of Allergy and Infectious Disease, and colleagues wrote. “Although rates of [chronic kidney disease], proteinuria and impairment in glomerular filtration rate have decreased since the pre-[highly active antiretroviral therapy] era, [antiretroviral therapy (ART)] use, especially tenofovir disoproxil fumarate, is linked to renal toxicities. Despite strong findings of renal toxicity and BMD loss in cross-sectional studies of HIV-infected patients, the full implications for perinatally infected individuals who are now young adults are still unclear.”

The researchers recruited 65 young adults infected with HIV perinatally or in early childhood and 23 controls without HIV for a cross-sectional study comparing participants’ renal function, bone turnover and BMD. Median age was 24 years for patients with HIV and 25 years for controls.

Patients with HIV had lower whole-body BMD compared with controls (1.15 g/cm²  vs. 1.21 g/cm²; P = .005), the researchers reported, as well as lower BMD z scores (P = .02). Those with HIV also had elevated NTX-telopeptide levels (P = .01), higher osteocalcin (P = .007) and parathyroid hormone (P = .03) levels, and increased albumin/creatinine and protein/creatinine ratios.

Tenofovir duration was correlated with higher anion gap among patients with HIV, but not with bone parameters, Unsal and colleagues wrote. Longer exposure to didanosine and stavudine were both correlated with lower BMD and BMD z scores. The researchers wrote that both bone metabolism and BMD improved over a median 4.4 years of follow-up, according to a longitudinal analysis. No patient’s eGFR was less than 60; however, longer duration of tenofovir exposure was correlated with a decline in eGFR.

 “The observed subclinical but significant differences in bone and renal health in this HIV cohort may emerge clinically as the cohort ages and acquires other comorbidities,” the researchers wrote. “Longitudinal studies of perinatally infected HIV cohorts as they progress into adulthood, especially in larger resource-poor settings, are needed to verify these findings.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.