Bone Update: Is It Still an Issue Without Tenofovir Disoproxil Fumarate?

Bone Update: Is It Still an Issue Without Tenofovir Disoproxil Fumarate?
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DOI:
10.1007/s11904-019-00474-1
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发表时间:
2020-03
影响因子:
4.6
通讯作者:
Yin MT
Yin MT
中科院分区:
医学2区
文献类型:
--
作者:
Shiau S;Arpadi SM;Yin MT

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在针对HIV感染者(PLWH)的现代骨骼友好型抗逆转录病毒治疗(ART)方案时代,本综述讨论了对于已经暴露于ART对骨代谢产生负面影响的个体,特别是尚未获得峰值骨量的儿童和青少年以及具有额外骨折危险因素的老年人,仍然存在的研究空白和管理问题。目前的数据支持在骨折风险增加的PLWH中避免使用TDF和使用骨友好方案,包括整合酶链转移抑制剂,用于ART起始或转换。尽管我们对PLWH患者选择抗逆转录病毒治疗对骨骼健康的影响的理解取得了重大进展,但还需要额外的诊断测试来确定骨折风险和治疗策略,特别是在弱势PLWH人群中,如儿童、青少年和老年人。
In the era of modern bone-friendly antiretroviral therapy (ART) regimens for people living with HIV (PLWH), this review discusses the research gaps and management concerns that remain for individuals who have already been exposed to ART with negative effects on bone metabolism, especially children and adolescents who have not acquired peak bone mass, and older adults who have additional risk factors for fracture. Data now support the use of avoidance of TDF and use of bone friendly regimens that include integrase strand transfer inhibitors in PLWH with increased risk of fracture either for ART initiation or switch. Despite significant advances in our understanding of ART choice for PLWH with regard to bone health, additional diagnostic tests to determine fracture risk and management strategies beyond ART choice are necessary, especially in vulnerable PLWH populations, such as children and adolescents and older adults.
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