A 10-year follow-up of bone mineral density in HIV-infected youths receiving tenofovir disoproxil fumarate

BACKGROUND: The use of tenofovir disoproxil fumarate (TDF) has simplified the antiretroviral regimen for HIV-infected patients and improved their compliance with treatment, but it has been associated with decreased bone mineral density (BMD) in adult patients, and data in pediatric patients are debated. The aim of the current study was to assess the long-term effect of TDF on BMD in young patients. METHODS: BMD was measured at the lumbar spine and in the whole skeleton in 26 HIV-infected youths (13 female and 13 male, aged 5 to 17 years at baseline). BMD was measured yearly for 10 years as part of standard care. BMD changes were compared with those calculated from 202 healthy subjects aged 3 to 24 years. FINDINGS: All patients had good control of the infection during the 10-year study. BMD measurements changed significantly (P<0⋅0001) in HIV-infected youths. The mean annual BMD increment at the lumbar spine was 0⋅046 (0⋅006) g/cm2 and 0⋅042 (0⋅006) g/cm2 in males and females, respectively. The differences between the slopes of patients and healthy controls were not significant. The annual BMD increment of the whole skeleton was 0⋅030 (0⋅005) g/cm2 in males and 0⋅019 (0⋅004) g/cm2 in females. The slopes of BMD changes of patients and healthy controls did not differ significantly. INTERPRETATION: These data indicate that treatment with a TDF-containing antiretroviral regimen does not impair BMD in young patients with HIV-infection. Larger studies are needed to confirm these results.