Inadequate PTH Response to Hypocalcemia in People Living with HIV

Page: [200 - 203] Pages: 4

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Abstract

Background: Small experimental studies suggest that PTH-secretion following hypocalcemia might be blunted in people living with HIV.

Objective: The aim of the study was to estimate the frequency of inadequately low concentrations of parathyroid hormone in the presence of hypocalcemia in people living with HIV.

Methods: This was a retrospective study that was conducted among PLWH enrolled in the ongoing ArcHIV study between 2016 and 2017. PLWH with routine measurements for both calcium and parathyroid hormone levels were included in this analysis. The proportion of patients with a combination of low levels of both calcium and parathyroid hormone was the primary endpoint of this analysis.

Result: 496 PLWH were included (mean age 47.1 (± 10.2) years, 393 (79.2 %) men). In 14 (2.8 %) PLWH, low calcium levels with low levels of PTH were observed in the assessment conducted in both years. Undergoing a tenofovir disoproxil-containing treatment in both years was the only explanatory variable significantly associated with inadequately low levels of PTH in the presence of hypocalcemia in both years (OR 4.3 [CI95: 1.4; 16.0]).

Conclusion: The combination of low levels of both calcium and PTH was found more frequent in our study sample when compared to what is expected from the general population. Interestingly, undergoing a tenofovir disoproxil-containing therapy was associated with this combination throughout both the years.

Keywords: Hypoparathyroidism, tenofovir disoproxil, hypocalcemia, TDF, antiretroviral therapy, ART.

[1]
Kuehn EW, Anders HJ, Bogner JR, Obermaier J, Goebel FD, Schlöndorff D. Hypocalcaemia in HIV infection and AIDS. J Intern Med 1999; 245(1): 69-73.
[http://dx.doi.org/10.1046/j.1365-2796.1999.00407.x] [PMID: 10095819]
[2]
Hellman P, Albert J, Gidlund M, et al. Impaired parathyroid hormone release in human immunodeficiency virus infection. AIDS Res Hum Retroviruses 1994; 10(4): 391-4.
[http://dx.doi.org/10.1089/aid.1994.10.391] [PMID: 7915122]
[3]
Faure GC, Tang JQ, Mathieu P, Bene MCAA. CD4-like molecule can be expressed in vivo in human parathyroid. J Clin Endocrinol Metab 1990; 71(3): 656-60.
[http://dx.doi.org/10.1210/jcem-71-3-656] [PMID: 1697598]
[4]
Hellman P, Karlsson-Parra A, Klareskog L, et al. Expression and function of a CD4-like molecule in parathyroid tissue. Surgery 1996; 120(6): 985-92.
[http://dx.doi.org/10.1016/S0039-6060(96)80044-4] [PMID: 8957484]
[5]
Thakker RV. Hypocalcemia: Pathogenesis, differential diagnosis, and management. Am Soc Bone Min Res 2006; 35: 213.
[6]
Sandhu S, Desai A, Batra M, et al. Severe symptomatic hypocalcemia from HIV related hypoparathyroidism. Case reports in endocrinology 2018; 2018.
[7]
Lehmann R, Leuzinger B, Salomon F. Symptomatic hypoparathyroidism in acquired immunodeficiency syndrome. Horm Res 1994; 42(6): 295-9.
[http://dx.doi.org/10.1159/000184212] [PMID: 7698727]
[8]
Gafni RI, Collins MT. Hypoparathyroidism. N Engl J Med 2019; 380(18): 1738-47.
[http://dx.doi.org/10.1056/NEJMcp1800213] [PMID: 31042826]
[9]
Noe S, Heldwein S, Jaeger H, Page M, Wolf E. Tenofovir disoproxil fumarate/emtricitabine is associated with a higher risk of hypocalce-mia compared to abacavir/lamivudine - results from a German cohort study. Int J STD AIDS 2019; 30(5): 447-52.
[http://dx.doi.org/10.1177/0956462418815022] [PMID: 30630396]
[10]
Centeno PP, Herberger A, Mun H-C, et al. Phosphate acts directly on the calcium-sensing receptor to stimulate parathyroid hormone secre-tion. Nat Commun 2019; 10(1): 4693.
[http://dx.doi.org/10.1038/s41467-019-12399-9] [PMID: 31619668]
[11]
Lee D, Yun BC, Seo KI, et al. Risk factors associated with hypophosphatemia in chronic Hepatitis B patients treated with tenofovir disoproxil fumarate. Medicine (Baltimore) 2019; 98(50): e18351.
[http://dx.doi.org/10.1097/MD.0000000000018351] [PMID: 31852136]
[12]
Cheng C-Y, Chang S-Y, Lin M-H, Ku S-Y, Sun N-L, Cheng S-H. Tenofovir disoproxil fumarate-associated hypophosphatemia as deter-mined by fractional excretion of filtered phosphate in HIV-infected patients. J Infect Chemother 2016; 22(11): 744-7.
[http://dx.doi.org/10.1016/j.jiac.2016.08.008] [PMID: 27613487]
[13]
Chin K-Y, Nirwana SI, Ngah WZW. Significant association between parathyroid hormone and uric acid level in men. Clin Interv Aging 2015; 10: 1377-80.
[http://dx.doi.org/10.2147/CIA.S90233] [PMID: 26346636]
[14]
Hui JY, Choi JWJ, Mount DB, Zhu Y, Zhang Y, Choi HK. The independent association between parathyroid hormone levels and hyperu-ricemia: A national population study. Arthritis Res Ther 2012; 14(2): R56.
[http://dx.doi.org/10.1186/ar3769] [PMID: 22405053]
[15]
Teal TK, Wood JL, Stevens PE, Lamb EJ. Stability of Bio-Intact (1-84) parathyroid hormone ex vivo in serum and EDTA plasma from hemodialysis patients. Clin Chem 2004; 50(9): 1713-4.
[http://dx.doi.org/10.1373/clinchem.2004.037994] [PMID: 15331521]
[16]
Oddoze C, Lombard E, Portugal H. Stability study of 81 analytes in human whole blood, in serum and in plasma. Clin Biochem 2012; 45(6): 464-9.
[http://dx.doi.org/10.1016/j.clinbiochem.2012.01.012] [PMID: 22285385]
[17]
Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of hypoparathyroidism: Etiologies and clinical features. J Clin Endocrinol Metab 2016; 101(6): 2300-12.
[http://dx.doi.org/10.1210/jc.2015-3909] [PMID: 26943721]