Certain antiretroviral drugs can have adverse effects on bone and renal health in young adults infected with HIV in early life, researchers report.
“Cumulative exposure to antiretroviral medications may have long-term health implications for young adults with life-long HIV,” Dr. Colleen M. Hadigan from the National Institute of Allergy and Infectious Diseases, in Bethesda, Maryland, told Reuters Health by email. “However, newer antiretroviral options are now available which may ameliorate or avoid renal and bone health impairment in the future.”
Long-term HIV infection and its treatment have been linked to renal disease, abnormalities in bone mineral density (BMD) and osteoporosis, but the full implications for perinatally infected individuals who are now young adults remain unclear.
Dr. Hadigan’s team used data from two prospective cohort studies of adolescents and young adults who acquired HIV perinatally or in early childhood to evaluate the impact of HIV infection and antiretroviral therapy (ART) use on renal function and bone health.
Most of the 65 HIV-infected young adults were on ART at last follow-up with a median duration of 15.8 years; 57% had an HIV viral load <40 copies/mL. The study also included 23 HIV-uninfected controls.
Whole-body BMD was 1.15 g/cm2 in the HIV group, significantly less than the 1.21 g/square cm in controls, according to report, online May 22 in The Journal of Clinical Endocrinology and Metabolism.
NTX-telopeptide (a urinary marker of bone resorption), osteocalcin (a marker of bone turnover) and parathyroid hormone (PTH) were significantly elevated in the HIV-infected group.
Exposure to didanosine and stavudine was associated with lower whole-body BMD, but other antiretroviral agents were not associated with lower BMD.
HIV-infected subjects had higher urine protein/creatinine ratio, albumin/creatinine ratio and anion gap - subclinical markers of renal dysfunction - but the prevalence of proteinuria and albuminuria and the age-adjusted GFR did not differ between patients and controls.
Over time, BMD increased and markers of bone turnover tended to normalize among HIV-infected patients. Measures of proteinuria and albuminuria did not change significantly.
Increases in anion gap and decreases in GFR were associated with increased duration of exposure to tenofovir.
“While there was evidence of dysregulation in renal function and lower bone mineral density relative to healthy volunteers, it was very encouraging to observe improvements in the measured bone parameters over time as this cohort ages into adulthood,” Dr. Hadigan said.
“We continue to inform HIV treatment practices with our growing appreciation of both efficacy and toxicity of HIV therapies,” she said. “This report helps to further that knowledge and may guide antiretroviral choices for HIV-infected adolescents and young adults to help minimize undesired effects on renal and bone health.”
“The observed subclinical but significant differences in bone and renal health in this HIV cohort may emerge clinically as the cohort ages and acquires other comorbidities,” the researchers conclude. “Longitudinal studies of perinatally infected HIV cohorts as they progress into adulthood, especially in larger resource-poor settings are needed to verify these findings.”
By Will Boggs
J Clin Endocrinol Metab 2017.