Short Communication: Inadequate Vitamin D Exacerbates Parathyroid Hormone Elevations in Tenofovir Users

Childs, Kathryn; Fishman, Sarah L.; Constable, Catherine; Gutiérrez, Julio; Wyatt, Christina M.; Dieterich, Douglas T.; Mullen, Michael P.; Branch, Andrea D.

doi:10.1089/aid.2009.0308

Cited by 57 publications

(36 citation statements)

References 14 publications

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“…TDFassociated bone changes may occur through a TDF effect on parathyroid hormone (16,20), as parathyroid hormone secretion increases soon after initiating TDF (21). Vitamin D deficiency (22) may exacerbate this increase in parathyroid hormone (20,23), but TDF-associated increased parathyroid hormone is found even in persons with sufficient vitamin D (24). Short-term vitamin D supplementation reduces TDF-associated increased parathyroid hormone but does not ameliorate TDF-associated phosphate loss (24,25).…”

mentioning

confidence: 99%

Association of Higher Plasma Vitamin D Binding Protein and Lower Free Calcitriol Levels with Tenofovir Disoproxil Fumarate Use and Plasma and Intracellular Tenofovir Pharmacokinetics: Cause of a Functional Vitamin D Deficiency?

Havens

Kiser

Stephensen

et al. 2013

Antimicrob Agents Chemother

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confidence: 99%

Association of Higher Plasma Vitamin D Binding Protein and Lower Free Calcitriol Levels with Tenofovir Disoproxil Fumarate Use and Plasma and Intracellular Tenofovir Pharmacokinetics: Cause of a Functional Vitamin D Deficiency?

Havens

Kiser

Stephensen

et al. 2013

Antimicrob Agents Chemother

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“…42,60 In some studies designed for the purpose, PTH concentration or prevalence of sHPTH was found to be consistently associated with 25OHD level and/or ART therapy (PIs and NNRTIs). 7,34,36,[39][40][41][42]45,51 Three articles, in particular, found a correlation between tenofovir use and higher parathyroid hormone concentrations. 7,36,39 In addition, Masia et al evaluated changes in PTH after the initiation of two different ART regimens.…”

Section: Secondary Hyperparathyroidism and Parathyroid Hormone Statusmentioning

confidence: 99%

“…7,34,36,[39][40][41][42]45,51 Three articles, in particular, found a correlation between tenofovir use and higher parathyroid hormone concentrations. 7,36,39 In addition, Masia et al evaluated changes in PTH after the initiation of two different ART regimens. 7 Both regimens produced significant increases in PTH concentration, and in the proportion of patients presenting with sHPTH during the follow-up period.…”

Section: Secondary Hyperparathyroidism and Parathyroid Hormone Statusmentioning

confidence: 99%

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Vitamin D deficiency in HIV-infected patients: a systematic review

Giusti¹,

Penco²,

Pioli³

2011

NDS

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Advances in the diagnosis and management of human immunodeficiency virus (HIV) have resulted in a dramatic decrease in mortality in HIV-infected individuals (HIV+). The subsequent increase in life expectancy of HIV+ has led to the need to consider the long-term complications of the disease and its treatment. Abnormalities in vitamin D status and metabolism are increasingly recognized as a major concern in HIV infection. In the last 5 years a number of cross-sectional and prospective studies have suggested a high prevalence of vitamin D deficiency in HIV+. Although few case-control studies have been published, it has been suggested that the prevalence of hypovitaminosis D in HIV+ is higher than in the general population, and at least in part, is related to the course of the disease and/or the antiretroviral drugs used to treat the disease. An adequate vitamin D status is important not only for bone tissue, but also for the global health status of HIV+ individuals, since a growing body of evidence has demonstrated the detrimental effects of vitamin D deficiency on multiple health outcomes. Therefore, definition of the size of the problem and identification of effective protocols for the prevention and management of vitamin D deficiency in HIV+ patients represent important steps in improving health status and reducing long-term chronic complications in individuals with HIV. Due to its immunomodulatory effects, vitamin D may also have implications in the progression of HIV infection. This systematic review was designed to determine the prevalence of vitamin D deficiency in HIV+ patients; to identify risk factors (related to the HIV infection or not) potentially associated with this condition; to describe the potential consequences of hypovitaminosis D on the course of the infection and the benefits of vitamin D repletion; and to make some suggestions about the future, considering the limitations of previous studies.

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“…9 However, elevated serum concentrations of PTH were more profound in patients with vitamin D (VitD) deficiency. 10,11,12 Tenofovir disoproxil fumarate undergoes initial di-ester hydrolysis in plasma to tenofovir (TFV). A proposed bone loss mechanism associated with TFV, a phosphonate, is selective uptake by osteoclasts via a mechanism similar to that of bisphosphonates, which eventually cause cellular stress.…”

Section: Introductionmentioning

confidence: 99%

Bone turnover markers in HIV-infected women on tenofovir-based antiretroviral therapy

Mulubwa

Viljoen

Kruger

et al. 2017

South. Afr. j. HIV med.

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How to cite this article:Mulubwa M, Viljoen M, Kruger IM, Kruger HS, Rheeders M. Bone turnover markers in HIV-infected women on tenofovir-based antiretroviral therapy. S Afr J HIV Med. 2017;18(1), a739. https://doi.org/10.4102/ sajhivmed.v18i1.739 IntroductionLow bone mineral density (BMD) is common among persons infected with human immunodeficiency virus (HIV).1 In HIV-infected people, causes of osteoporosis, fractures and low BMD are multifactorial, involving traditional risk factors (smoking, alcohol use, low body weight and physical inactivity), but also genetics and HIV-infection per se.1,2 Exposure to antiretroviral treatment (ART), especially nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) in HIV-infected people, is associated with low BMD.3 Osteomalacia was reported in patients on a tenofovir disoproxil fumarate (TDF)-based ART regimen that was characteristic of hypophosphataemia and increased serum alkaline phosphatase (ALP). 4In clinical studies, TDF-based ART regimens were reported to be associated with decreased BMD, characterised by increased serum concentrations of bone turnover markers (BTMs). These include bone resorption markers such as C-terminal telopeptide (CTx) and bone formation markers such as procollagen type 1 N-terminal propeptide (P1NP), bone-specific ALP (BALP) osteocalcin and ALP. 5,6,7,8 Furthermore, increased bone turnover, after initiation of TDF therapy, was characterised by elevated serum concentrations of parathyroid hormone (PTH).9 However, elevated serum concentrations of PTH were more profound in patients with vitamin D (VitD) deficiency. 10,11,12 Tenofovir disoproxil fumarate undergoes initial di-ester hydrolysis in plasma to tenofovir (TFV). A proposed bone loss mechanism associated with TFV, a phosphonate, is selective uptake by osteoclasts via a mechanism similar to that of bisphosphonates, which eventually cause cellular stress. 13 Resulting cellular stress perturbs deoxyribonucleic (DNA) synthesis by altering gene expression that is involved in signalling osteoblast activity resulting in decreased bone formation.13,14 Despite studies 3,5,7 performed on the relationship between TDF-use and bone Background: Tenofovir disoproxil fumarate (TDF) antiretroviral therapy is associated with disruption of the bone turnover process. Objectives: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. Method:A cross-sectional sub-study included 30 HIV-infected women on TDF and 30 HIVuninfected 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 t-test, analysis of covariance, regression and correlation anal...

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Short Communication: Inadequate Vitamin D Exacerbates Parathyroid Hormone Elevations in Tenofovir Users

Cited by 57 publications

References 14 publications

Association of Higher Plasma Vitamin D Binding Protein and Lower Free Calcitriol Levels with Tenofovir Disoproxil Fumarate Use and Plasma and Intracellular Tenofovir Pharmacokinetics: Cause of a Functional Vitamin D Deficiency?

Association of Higher Plasma Vitamin D Binding Protein and Lower Free Calcitriol Levels with Tenofovir Disoproxil Fumarate Use and Plasma and Intracellular Tenofovir Pharmacokinetics: Cause of a Functional Vitamin D Deficiency?

Vitamin D deficiency in HIV-infected patients: a systematic review

Bone turnover markers in HIV-infected women on tenofovir-based antiretroviral therapy

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