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Long-Term Treatment with Tenofovir in Asian-American Chronic Hepatitis B Patients Is Associated with Abnormal Renal Phosphate Handling

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Abstract

Background

Increased risk of defective urinary phosphate reabsorption and osteoporosis has been reported in HIV and chronic hepatitis B (CHB) patients treated with tenofovir disoproxil fumarate (TDF).

Aims

Goals of this study were to evaluate the prevalence of renal phosphate wasting and abnormal bone mineral density in CHB patients taking TDF compared to CHB patients treated with entecavir (ETV) and untreated CHB patients.

Methods

This is a cross-sectional study of 146 consecutive Asian-American CHB patients who were treatment naïve (n = 60) or treated with either TDF (n = 42) or ETV (n = 44). Proximal tubular handling of phosphate was assessed by the maximal rate of tubular reabsorption of phosphate (TmPO4) divided by glomerular filtration rate (GFR) (TmPO4/GFR). Bone mineral density (BMD) was measured using dual X-ray absorptiometry.

Results

TmPO4/GFR was similar among CHB patients treated with TDF compared to untreated patients and patients taking ETV. However, among patients treated with ≥18 months of TDF or ETV, prevalence of abnormal TmPO4/GFR was higher among patients treated with TDF compared to ETV (48.5 % (16/33) vs. 12.5 % (3/24), p = 0.005). Overall prevalence of osteoporosis in this cohort of CHB patients was 14 %, with no significant difference between the three groups. Renal phosphate handling did not correlate with osteoporosis.

Conclusions

Chronic hepatitis B patients treated with ≥18 months of TDF experienced an increased risk of proximal tubular dysfunction. TDF did not increase the risk of osteoporosis. Longitudinal studies are needed to confirm these findings.

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Acknowledgments

The authors acknowledge the efforts of the Volunteer Team at the Asian Pacific Liver Center at Saint Vincent Medical Center for the weekly community screenings for chronic hepatitis B infection. Our thanks also go to Dr. Myron J. Tong for reading this manuscript and his thoughtful comments.

Conflict of interest

Tse-Ling Fong and Ho S. Bae have consultancy agreements with and receive research support from Bristol-Myers-Squibb and Gilead Sciences. The remaining authors have no conflicts of interest to disclose. The Daughters of Charity Foundation and Gilead Sciences provided funding for the study. No funding was provided in the writing of the manuscript. The authors had complete access to the data that supports the publication.

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Authors and Affiliations

  1. Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA

    Connie Tien, Jason J. Xu, Mimi Chang, Carolina Lim, Sue Lee, Ho S. Bae & Tse-Ling Fong

  2. Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, 2/F, Los Angeles, CA, 90033, USA

    Linda S. Chan, Shuntaro Shinada & Tse-Ling Fong

  3. Rheumatology Private Practice, Los Angeles, CA, USA

    Brian Huh

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  1. Connie Tien
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  2. Jason J. Xu
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  5. Carolina Lim
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Correspondence to Tse-Ling Fong.

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Tien, C., Xu, J.J., Chan, L.S. et al. Long-Term Treatment with Tenofovir in Asian-American Chronic Hepatitis B Patients Is Associated with Abnormal Renal Phosphate Handling. Dig Dis Sci 60, 566–572 (2015). https://doi.org/10.1007/s10620-014-3363-4

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  • DOI: https://doi.org/10.1007/s10620-014-3363-4

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