Apr 24, 2013
Hello doc I am on truvada + prezista + norvir from 1 year. Undetectable after 2 months and CD4 600. Had my bones scan and results show some osteopenia. My doc is considering to stop truvada. What new regimen would you suggest? I am afraid to start new drugs because I was doing fine with this. At least I wish to have a simplification.
Response from Dr. Henry
The bone story in HIV+ patients on treatment is complicated and not fully understood. First, osteopenia is fairly common in the general population with low vitamid D levels, low testosterone levels, alcohol and tobacco use, underweight/inactivity and other causes contributing. ALthough the tenofovir in Truvada has been linked to bone problems the overall rate of clinically significant problems has been low. Furthermore, a number of studies have shown that starting effective HIV treatment (with or without tenofovir) is associated with a modest decrease in bone mineral density in the first 6-12 months and then the situation appears to stabilize. Osteopenia reflects less of a bone mineral loss than osteporosis so if you have osteopenia as determined by DEXA scanning that is not necessarily a reason to switch off Truvada (working on other risk factors and taking vitamin D and calcium supplements often recommended in that setting). Whether switching to alternative HIV regimen (ie abacavir instead of tenofovir DF if HLA *B5701 negative) results in clinically significant improvement has not been proven but may be considered in some cases. KH
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