Study Examines Effects of Antiretroviral Therapy on Bone and Kidney Health

Antiretroviral therapy (ART) was associated with markers of renal dysfunction and poor bone health in young adults with lifelong HIV, according to the findings of a recent study.

The cross-sectional study included 65 young adults who were born with HIV and started ART in early life, and 23 healthy controls. Bone mineral density (BMD), bone turnover, and renal function were compared. In addition, 33 participants with HIV were included in a subset analysis to assess longitudinal impacts of ART on renal and bone health, and were followed for 4.4 years.
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Compared with controls, albumin/creatinine ratio, protein/creatinine ratio, anion gap, NTX-telopeptides, and osteocalcin were significantly higher in individuals with HIV. Individuals with HIV had lower BMD and BMD Z-scores compared with healthy controls.

The duration of tenofovir (TDF) was associated with higher anion gap in individuals with HIV, and longer duration of didanosine and stavudine therapy was associated with lower BMD and BMD Z-scores.

None of the participants had an estimated glomerular filtration rate (eGFR) below 60, however, the researchers found an association between declining eGFR in individuals with HIV and increasing years of TDF exposure.

However, BMD and bone metabolism was found to improve significantly over time in longitudinal analyses.

“Subclinical markers of renal dysfunction were increased in HIV-infected young adults and associated with TDF exposure, whereas lower bone density was associated with didanosine and stavudine exposure,” the researchers concluded. “The tendency for improvement in markers of bone health over time and the availability of less toxic ARV alternatives may herald improvements in renal and bone health for perinatally infected patients in adulthood.”

—Melissa Weiss

Reference:

Unsal AB, Mattingly AS, Jones SE, et al. Effect of antiretroviral therapy on bone and renal health in young adults infected with HIV in early life [published online May 22, 2017]. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2017-00197.