Evaluation of hypophosphataemia in tenofovir disoproxil fumarate (TDF)-exposed and TDF-unexposed HIV-infected out-patients receiving highly active antiretroviral therapy

Kate Buchacz*, John T. Brooks, Tony Tong, Anne C. Moorman, Rose K. Baker, S. D. Holmberg, A. Greenberg, Kathleen C. Wood, Carl Armon, James T. Richardson, Frank J. Palella, Joan S. Chmiel, Katharine A. Kirby, Janet Cheley, Tiffany Murphy, Kenneth A. Lichtenstein, Kenneth S. Greenberg, Benjamin Young, Barbara Widick, Cheryl StewartPeggy Zellner, Bienvenido G. Yangco, Kalliope Halkias, Arletis Lay, Douglas J. Ward, Charles A. Owen, Jack Fuhrer, Linda Ording-Bauer, Rita Kelly, Jane Esteves, Ellen M. Tedaldi, Ramona A. Christian, Linda Walker-Kornegay, Joseph B. Marzouk, Roger T. Phelps, Mark Rachel, Silver Sisneros, Richard M. Novak, Jonathan P. Uy, Andrea Wendrow

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Objectives: Cases of hypophosphataemia (often coincident with renal dysfunction) have been reported in HIV-infected patients taking tenofovir disoproxil fumarate (TDF), but randomized placebo-controlled trials of HIV-infected persons with normal baseline renal function have found a comparable incidence of hypophosphataemia in the TDF and placebo groups. We assessed the incidence of grade 2 and higher hypophosphataemia in the HIV Outpatient Study (HOPS). Methods: We analysed a prospective cohort of patients who initiated either a TDF-containing highly active antiretroviral therapy (HAART) regimen [TDF-exposed (TDF +) group; n =165] or a TDF-sparing HAART regimen [TDF-unexposed (TDF-) group; n =90], and who had normal baseline phosphate and creatinine values. Results: The TDF+and TDF-groups had comparable median follow-up times (10.9 vs 8.8 months, respectively; P =0.18) and number of phosphate measurements (median=3 for both) and were similar on most clinical and demographic factors. During follow up, 12.7% of TDF+ vs 6.7% of TDF-patients developed grade 2 hypophosphataemia (2.0-2.4 mg/dL), and 2.4% of TDF+ patients vs 0% of TDF-patients developed grade 3 hypophosphataemia (1.0-1.9 mg/dL); none developed grade 4 hypophosphataemia (<1.0 mg/dL). The incidence of grade 2 or higher hypophosphataemia was 16.7 per 100 person-years among TDF+ patients vs 8.0 per 100 person-years among TDF-patients (P = 0.11). Conclusions: The incidence of hypophosphataemia was somewhat elevated in HOPS patients who took TDF-containing HAART compared with those who took TDF-sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant. Longer follow-up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphataemia.

Original languageEnglish (US)
Pages (from-to)451-456
Number of pages6
JournalHIV Medicine
Volume7
Issue number7
DOIs
StatePublished - Oct 2006

Keywords

  • HAART
  • Renal disease
  • Serum phosphate
  • Tenofovir
  • Toxicity

ASJC Scopus subject areas

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)

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