Bone loss on TVD prep

Presentation by Andrew Carr.

Bone loss in 1st year of ART is a well established fact.

Loss is more on tenofovir containing regimes 2.4-3.8%  non tenofovir 0.7-2.5%.

Compare to 1 year 10mg prednisolone 0.8 -3% loss

PREP tdf-ftc

4RTC's show 0.5-1.5% loss BMD over 12-30 months!

          Reversible  if stopped  after 1 year

             Reversibility not established for longer periods, prep may be long term

Proportion of those with greater bone is uncertain

            >3% loss at hip and LSS in 25-50%

Non adherence issues in early RCTs , so bone loss may be underestimated.

Study 36 men taking TDF-FTC PrEP on prelude trialNSW,av age 38, av weight 79.9,TDF exposure pretrial 6months.

Average BMD loss - 2.2 spine,-2.5 fem neck,but,approx 45% lost>3%, 25% lost>5% BMD

Study limitations :no control,no women,some loss attribuible to age, 1 year data only,no PK data

Needs:

Longer f/up, data on secondary causes of BMD loss,more patients to identify risks for the greater loss group