The Effect of Tenofovir Disoproxil Fumarate on Bone Mineral Density: A Systematic Review and Meta-Analysis

Baranek, Benjamin; Wang, Shaoyuan; Cheung, Angela M.; Mishra, Sharmistha; Tan, Darrell H. S.

doi:10.3851/imp3346

Cited by 39 publications

(35 citation statements)

References 48 publications

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“…Adapted from Refs. [10,[26][27][28][29][30][31][32]. AI aromatase inhibitor, PostMW postmenopausal women, PreMW, premenopausal women, GnRH Gonadotropin-Releasing Hormone, GC glucocorti-coids, ART antiretroviral treatment, PLWH people living with HIV, TDF tenofovir disoproxil fumarate, PrEP HIV pre-exposure prophylaxis and macrophages help create a microenvironment that promotes the recruitment of osteoclasts [45].…”

Section: Change Of Spine Bmd At One Year (%)mentioning

confidence: 99%

Osteoporosis and HIV Infection

Biver

2022

Calcif Tissue Int

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Life expectancy of people living with HIV (PLWH) is now close to that of the HIV-uninfected population. As a result, age-related comorbidities, including osteoporosis, are increasing in PLWH. This narrative review describes the epidemiology of bone fragility in PLWH, changes of bone features over the course of HIV infection and their determinants, as well as the available evidence regarding the management of osteoporosis in PLWH. The risk of fracture is higher and increases about 10 years earlier compared to the general population. The classical risk factors of bone fragility are very widespread and are major determinants of bone health in this population. The majority of bone loss occurs during virus replication and during immune reconstitution at antiretroviral therapies (ART) initiation, which both increase osteoclast activity. Abnormalities in bone formation and mineralization have also been shown in histomorphometric studies in untreated PLWH. Measurement of bone mineral density (BMD) is the first line tool for assessing fracture risk in postmenopausal women, men above 50 years, and other HIV-infected patients with clinical risk factors for osteoporosis. FRAX underestimates fracture probability in PLWH. In case of indication for anti-osteoporotic drug, bisphosphonates remain the reference option. Calcium and vitamin D supplementation should be considered as ART initiation, since it may attenuate bone loss at this stage. Bone-protective ART regimens improve BMD compared to other regimens, but to a lesser extent than bisphosphonate, and without available data on their influence on the incidence of fracture.

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Section: Change Of Spine Bmd At One Year (%)mentioning

confidence: 99%

Osteoporosis and HIV Infection

Biver

2022

Calcif Tissue Int

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“…F/TAF should be considered in any PrEP candidate meeting one or more of these criteria. Supporting Evidence F/TDF may be associated with declines in BMD when used for PrEP or HIV treatment, in comparison with F/TAF, which showed no effect on BMD [20]. A systematic review and meta-analysis included a mixed group of studies wherein F/TDF was used as PrEP, HIV treatment, and hepatitis B virus treatment [20].…”

Section: Consideration #5mentioning

confidence: 99%

“…A systematic review and meta-analysis included a mixed group of studies wherein F/TDF was used as PrEP, HIV treatment, and hepatitis B virus treatment [20]. When taken as PrEP, F/TDF was associated with a minor BMD decrease in the lumbar spine and total hip (mean differences of -0.82% and -0.81%, respectively), although a larger decrease in BMD was seen in the HIV treatment studies [20].…”

Section: Consideration #5mentioning

confidence: 99%

“…There are nevertheless important differences between F/TDF and F/TAF in terms of bone and renal safety [14]. The use of F/TDF has been associated with notable decreases in bone mineral density (BMD) and renal function [as measured by estimated glomerular filtration rate (eGFR)] both in individuals with HIV and in individuals who were HIV negative using PrEP [18][19][20]. F/TAF has been associated with improved maintenance of bone and renal safety parameters versus F/TDF in individuals with HIV [21].…”

Section: Introductionmentioning

confidence: 99%

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Patient-Focused Selection of PrEP Medication for Individuals at Risk of HIV: A Narrative Review

Fields

Tung

2021

Infect Dis Ther

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Pre-exposure prophylaxis (PrEP) medication is a key component of the HIV prevention strategy in the US, which has been demonstrated to be highly effective in preventing HIV acquisition among individuals at risk. Two PrEP medications are currently approved: emtricitabine/ tenofovir disoproxil fumarate (Truvada Ò ; F/TDF) was approved by the US Food and Drug Administration in 2012, followed by emtricitabine/tenofovir alafenamide (Descovy Ò ; F/TAF) in 2019. An ongoing randomized, double-blind, Phase 3 study (DISCOVER) demonstrated that F/TAF had non-inferior efficacy to F/TDF. While both medications have been found to be efficacious and well tolerated, several studies have identified that important differences exist with regards to pharmacokinetics, bone and renal safety profiles, and other factors. In this narrative review, we conducted a comprehensive evaluation of the populations at risk of HIV who may also be affected by, or at risk of, bone or renal conditions. We reviewed the safety profiles of F/TDF and F/TAF to develop an evidence-based algorithm for selecting the appropriate PrEP medication, based on biological, behavioral, and health characteristics of an individual at risk of HIV, and considered how the choice of PrEP medication may or may not compound safety concerns for these individuals. We identified that the introduction of F/TAF provides a valuable alternative to F/TDF, allowing the personalization of PrEP. F/TAF may be the preferred medication for cisgender men and transgender women at risk of HIV infection who are predisposed to, or already have, bone or renal conditions. While the approval of F/TAF is the first step in personalization of PrEP, additional options are still warranted to help accommodate the wide spectrum of individuals at risk of HIV with different lifestyles, medical histories, preferences, and requirements.

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“…Although these effects will likely only transpire in susceptible individuals following chronic uninterrupted use, two recent meta-analyses found no evidence to support severe TDF-induced renal or bone damage. 13,14 Interestingly, a recent in vitro study described the interaction between probenecid and TDF as well as the potential of such a combination to further reduce the risk of nephrotoxicity. 15 The efficacy of TDF in HIV is partly based on the accumulation of TDF in peripheral blood mononuclear cells (lymphocytes) and the consequent prolonged exposure thereof.…”

Section: Current Prep Guidelinesmentioning

confidence: 99%