Subscribe to RSS
DOI: 10.1055/s-0041-1728734
Proximal Femur Fracture (31-A3.2) Associated with the Use of Tenofovir by an HIV-positive Patient: Case Report
Article in several languages: español | English
Abstract
We present the first case report of a human immunodeficiency virus (HIV)-positive adult patient with a fragility fracture of the proximal femur associated with antiretroviral therapy (ART) with tenofovir disoproxil fumarate (TDF) in Chile. Currently, patients diagnosed with HIV start ART early, resulting in more years of exposure to these drugs. The accumulated exposure time to TDF has been associated with a decreased bone mineral density and progressive renal failure, potentially leading to acquired Fanconi syndrome, osteomalacia, and an increased risk of fracture. We present a case of a 44-year-old, HIV-positive man assessed at the emergency room after a fall from standing height which resulted in a proximal femoral pathological fracture. Laboratory findings at admission revealed hypokalemia, hypocalcemia, hypophosphatemia, and hypovitaminosis D. Multidisciplinary management was performed, with TDF discontinuation, ART change, and supplementation with calcium and vitamin D. Closed reduction and fixation with a long cephalomedullary nail was successful, with early motor rehabilitation, functional recovery, and bone consolidation at 12 weeks. Musculoskeletal pain in HIV-positive patients on ART must raise the clinical suspicion of an adverse drug effect; the follow-up of these subjects must include serial monitoring of renal function and serum calcium and phosphorus levels. Screening and suspicion of such complications would enable an early intervention, improving the patients' condition and preventing pathological fractures.
Publication History
Received: 25 May 2020
Accepted: 21 January 2021
Article published online:
02 June 2021
© 2021. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referencias
- 1 Tebas P, Powderly WG, Claxton S. et al. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 2000; 14 (04) F63-F67
- 2 Womack JA, Goulet JL, Gibert C. et al; Veterans Aging Cohort Study Project Team. Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS One 2011; 6 (02) e17217
- 3 Gallant JE, Staszewski S, Pozniak AL. et al; 903 Study Group. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA 2004; 292 (02) 191-201
- 4 Van Rompay KKA, Brignolo LL, Meyer DJ. et al. Biological effects of short-term or prolonged administration of 9-[2-(phosphonomethoxy)propyl]adenine (tenofovir) to newborn and infant rhesus macaques. Antimicrob Agents Chemother 2004; 48 (05) 1469-1487
- 5 Wanner DP, Tyndall A, Walker UA. Tenofovir-induced osteomalacia. Clin Exp Rheumatol 2009; 27 (06) 1001-1003
- 6 Bedimo R, Maalouf NM, Zhang S, Drechsler H, Tebas P. Osteoporotic fracture risk associated with cumulative exposure to tenofovir and other antiretroviral agents. AIDS 2012; 26 (07) 825-831
- 7 Hileman CO, Labbato DE, Storer NJ, Tangpricha V, McComsey GA. Is bone loss linked to chronic inflammation in antiretroviral-naive HIV-infected adults? A 48-week matched cohort study. AIDS 2014; 28 (12) 1759-1767
- 8 Shiau S, Arpadi SM, Yin MT. Bone Update: Is It Still an Issue Without Tenofovir Disoproxil Fumarate?. Curr HIV/AIDS Rep 2020; 17 (01) 1-5
- 9 Borges ÁH, Hoy J, Florence E. et al; for EuroSIDA. Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort. Clin Infect Dis 2017; 64 (10) 1413-1421
- 10 Hall AM, Hendry BM, Nitsch D, Connolly JO. Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence. Am J Kidney Dis 2011; 57 (05) 773-780
- 11 Lebrecht D, Venhoff AC, Kirschner J, Wiech T, Venhoff N, Walker UA. Mitochondrial tubulopathy in tenofovir disoproxil fumarate-treated rats. J Acquir Immune Defic Syndr 2009; 51 (03) 258-263
- 12 Duarte-Rojo A, Heathcote EJ. Efficacy and safety of tenofovir disoproxil fumarate in patients with chronic hepatitis B. Therap Adv Gastroenterol 2010; 3 (02) 107-119
- 13 Marco P, Cristian A, Isabel GM, Veronica V, Juan H. Bilateral Hip Fracture in Adolescents With Antiretroviral Treatment. J Am Acad Orthop Surg Glob Res Rev 2017; 1 (01) e005
- 14 Rebolledo BJ, Unnanuntana A, Lane JM. Bilateral pathologic hip fractures associated with antiretroviral therapy: a case report. J Bone Joint Surg Am 2011; 93 (14) e78
- 15 Carr A, Kerr SJ, Richardson R. et al; ZEST study Investigators. Prolonged Effect of Zoledronic Acid on Bone Mineral Density and Turnover in HIV-Infected Adults on Tenofovir: A Randomized, Open-Label Study. J Bone Miner Res 2019; 34 (12) 2192-2197
- 16 Bolland MJ, Grey A, Horne AM. et al. Effects of intravenous zoledronate on bone turnover and bone density persist for at least five years in HIV-infected men. J Clin Endocrinol Metab 2012; 97 (06) 1922-1928
- 17 Wijesekera MP, Graham SM, Lalloo DG, Simpson H, Harrison WJ. Fracture management in HIV positive individuals: a systematic review. Int Orthop 2016; 40 (12) 2429-2445