title: Short communication: Inadequate vitamin D exacerbates parathyroid hormone elevations in tenofovir users.
abstract: Parathyroid hormone (PTH) elevations are associated with reduced bone mineral density and adverse health outcomes and have been reported in patients with HIV infection. We aimed to examine the impact of vitamin D status and tenofovir (TDF) use on PTH levels among HIV-infected patients receiving combination antiretroviral therapy (cART). Demographics, medication and supplement use, and clinical data, including 25-hydroxyvitamin D [25(OH)D] and PTH, were collected on 45 HIV-infected men on ART. Suboptimal vitamin D status was defined as 25(OH)D < 30 ng/ml. The relationship between antiretroviral agents, suboptimal 25(OH)D, and PTH levels was examined. Among subjects with suboptimal vitamin D status, PTH values greater than or equal to the ULN (87 pg/ml) were more common among TDF users than nonusers: 41% versus 0% (p = 0.018); and median PTH was higher in TDF users: 80 pg/ml versus 55 pg/ml (p = 0.02). Among TDF users, PTH was higher in the group with suboptimal 25(OH)D (p = 0.045). Multivariable linear regression showed that PTH was independently and directly related to TDF use (p = 0.017) and inversely related to 25(OH)D (p = 0.017). PTH was not related to the estimated glomerular filtration rate (p = 0.9). In this cross-sectional study of HIV-infected men on ART, the use of TDF and the level of 25(OH)D were independently associated with PTH levels. Because TDF is a potent and widely used antiretroviral drug, information about cofactors that may exacerbate its side effects is of significant clinical value.
authors.affiliation: Division of Infectious Diseases, Mount Sinai School of Medicine, New York, New York 10029, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Childs
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Fishman
authors.forename: Catherine
authors.initials: C
authors.lastname: Constable
authors.forename: Julio A
authors.initials: JA
authors.lastname: Gutierrez
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wyatt
authors.forename: Douglas T
authors.initials: DT
authors.lastname: Dieterich
authors.forename: Michael P
authors.initials: MP
authors.lastname: Mullen
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Branch
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood*; D000068698:Tenofovir; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000209:etiology*
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D010281:Parathyroid Hormone; D014807:Vitamin D; D000068698:Tenofovir; C104450:25-hydroxyvitamin D; D000225:Adenine