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Tenofovir and bone health.

Philip M Grant1, Aoife G Cotter

  • 1aDivision of Infectious Diseases; Department of Medicine; Stanford University, Palo Alto, CA, USA bHIV Molecular Research Group, School of Medicine & Medical Science, University College Dublin cDepartment of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.

Current Opinion in HIV and AIDS
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Tenofovir disoproxil fumarate (TDF) may cause greater bone mineral density loss in HIV patients. Tenofovir alafenamide shows improved bone safety, suggesting a shift away from TDF in treatment regimens.

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Area of Science:

  • Bone health in HIV management
  • Antiretroviral therapy safety

Background:

  • Long-term safety of antiretroviral therapy (ART) is crucial as treatments improve.
  • HIV-infected individuals face higher risks of low bone mineral density and fractures.

Purpose of the Study:

  • Review mechanisms of tenofovir's bone toxicity.
  • Analyze clinical studies on tenofovir disoproxil fumarate (TDF) and bone health.
  • Examine recent bone data for tenofovir alafenamide (TAF).

Main Methods:

  • Literature review of studies on tenofovir and bone mineral density.
  • Comparative analysis of TDF versus other ART agents.
  • Evaluation of TAF's bone and renal safety profile.

Main Results:

  • Studies indicate TDF is associated with 1-3% greater bone mineral density loss compared to other agents.
  • Recent research shows TAF offers improved bone and renal safety over TDF.
  • Virologic efficacy remains similar between TDF and TAF.

Conclusions:

  • TDF-containing regimens may be phased out for HIV treatment.
  • Non-TDF regimens are recommended, particularly for patients at high risk of fracture.
  • TAF presents a safer alternative for bone health in HIV management.