Impact of Tenofovir-Based Pre-exposure Prophylaxis on Biomarkers of Bone Formation, Bone Resorption, and Bone Mineral Metabolism in HIV-Negative Adults

Thomas L. Nickolas, Michael T. Yin, Ting Hong, Kenneth K. Mugwanya, Andrea D. Branch, Renee Heffron, Janaina Ramalho, Renu Nandakumar, Elzbieta Dworakowski, Valentine Wanga, Nelly R. Mugo, Allan Ronald, Connie Celum, Deborah Donnell, Jared M. Baeten, Christina M. Wyatt, Robert W. Coombs, Lisa Frenkel, Craig W. Hendrix, Jairam R. LingappaM. Juliana McElrath, Kenneth H. Fife, Edwin Were, Elioda Tumwesigye, Patrick Ndase, Elly Katabira, Elizabeth Bukusi, Craig R. Cohen, Jonathan Wangisi, James D. Campbell, Jordan W. Tappero, James Kiarie, Carey Farquhar, Grace John-Stewart

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4 Scopus citations


Background: Pre-exposure prophylaxis (PrEP) with emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) reduces the risk of HIV seroconversion but may promote bone mineral density (BMD) decline. The mechanisms of BMD decline with FTC/TDF remain unclear, and studies in HIV-positive individuals have been confounded by the effects of HIV and concomitant antiretroviral medications. We evaluated the impact of FTC/TDF on biomarkers of bone remodeling and bone mineral metabolism in HIV-negative men and women enrolled in the Partners PrEP Study. Methods: In a random sample of HIV-negative participants randomized to FTC/TDF PrEP (n = 50) or placebo (n = 50), serum parathyroid hormone (PTH), bone biomarkers (C-telopeptide, procollagen 1 intact N-terminal propeptide, and sclerostin), and plasma fibroblast growth factor 23 were measured at baseline and month 24, and the percentage change was compared between groups. In a complementary analysis, we compared the change in biomarkers between participants with and without a 25% decline in glomerular filtration rate (GFR) on FTC/TDF. Results: Baseline characteristics were similar between the groups (median age, 38 years; 40% women). Vitamin D insufficiency was common, but baseline GFR and PTH were in the normal range. We observed a significantly greater percent increase in serum C-telopeptide in participants randomized to FTC/TDF vs placebo (P =. 03), suggesting an increase in bone remodeling. We observed no differences in the other biomarkers, or in a separate analysis comparing participants with and without a decline in GFR. Conclusions: Increased bone remodeling may mediate the BMD decline observed with tenofovir-containing PrEP and antiretroviral therapy, independent of a TDF-mediated decrease in kidney function.

Original languageEnglish
Article numberofz338
JournalOpen Forum Infectious Diseases
Issue number10
StatePublished - 30 Sep 2019


  • HIV prevention
  • antiretroviral therapy
  • bone turnover
  • kidney
  • tubular dysfunction


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