Bone outcomes in virally suppressed youth with HIV switching to tenofovir disoproxil fumarate

Kate Braithwaite, Tristan D. McPherson, Yanhan Shen, Stephen Arpadi, Stephanie Shiau, Gillian Sorour, Karl Günter Technau, Michael T. Yin

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Background: Tenofovir disoproxil fumarate (TDF) is included in first-line antiretroviral treatment (ART) for adolescents living with HIV (ALWH). Associated toxicities remain a concern. Objective: We evaluated bone and renal safety outcomes in virologically suppressed South African ALWH after switching to TDF. Method: We recruited virally suppressed (< 100 copies/mL) adolescents, aged 15-20 years, who switched from an abacavir (ABC)-based to a TDF-based efavirenz regimen. Bone mass and renal function were assessed at Week 0 and at Week 24 after the switch to TDF using dual-energy X-ray absorptiometry (DXA) and serum renal markers. A change in the lumbar spine (LS) and the whole-body less head (WBLH) bone mineral density (BMD) Z-scores and the estimated glomerular filtration rate (eGFR) between the two measures were compared (paired t-tests) and stratified by sex. Results: Fifty participants (48% male), with a median duration of prior ART of 11.4 years, were enrolled. Among 47 participants with 24-week DXA results, 15 (32%) had either no change or a decreased LS-BMD after the switch, with a mean change of -1.6%. Overall, more female participants experienced this outcome: 58% versus 4%, P < 0.0001. The mean change (standard deviation) in the LS-Z-score was -0.03 (0.25) and in the WBLH-Z-score was 0.02 (0.24). A decrease in the eGFR from 132.2 to 120.4 was observed (P = 0.0003); however, the levels remained clinically acceptable. Conclusion: South African ALWH switching from abacavir to TDF-based ART experienced statistically significant decreases in eGFR but not in LS and WBLH BMD. Female ALWH were more likely to experience a decrease in LS-BMD and may require closer monitoring.

Original languageEnglish (US)
Article numbera1243
JournalSouthern African Journal of HIV Medicine
Issue number1
StatePublished - 2021

All Science Journal Classification (ASJC) codes

  • Infectious Diseases


  • Adolescents
  • Bone
  • Renal
  • South Africa
  • Tenofovir disoproxil fumarate


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