Improvement in bone mineral density after switching from tenofovir to abacavir in HIV-1-infected patients with low bone mineral density: two-centre randomized pilot study (OsteoTDF study)

Tenofovir has been associated with a decrease in bone mineral density (BMD). However, data on changes in BMD after discontinuing tenofovir are lacking. We performed a two-centre randomized pilot study in virologically suppressed HIV-infected patients receiving tenofovir with osteopenia/osteoporosis (OsteoTDF study, ClinicalTrials.gov number NCT 01153217). Fifty-four patients were randomly assigned to switch from tenofovir to abacavir (naEuroS=aEuroS26) or to continue with tenofovir (naEuroS=aEuroS28). Changes in lumbar and total hip BMD were evaluated at Week 48 from baseline. Five patients discontinued the study (three from the tenofovir group and two from the abacavir group). No significant differences were detected between the groups at Week 48 (PaEuroS=aEuroS0.229 for total hip and PaEuroS=aEuroS0.312 for lumbar spine). However, hip BMD improved by 2.1% (95% CI -0.6 to 4.7) (PaEuroS=aEuroS0.043) in the abacavir group and 0.7% (95% CI -0.9 to 2.4) (PaEuroS=aEuroS0.372) in the tenofovir group. Lumbar spine BMD varied by -0.7% (95% CI -3.8 to 3.3) (PaEuroSa parts per thousand currency signaEuroS0.001) in the abacavir group and -1.2% (95% CI -3.8 to 0.4) (PaEuroS < aEuroS0.001) in the tenofovir group. Switching from tenofovir to abacavir led to a slight improvement in femoral BMD although no differences were detected between groups. Larger studies are necessary before firm recommendations can be made on the discontinuation of tenofovir in patients with a low BMD.