Osteopenia in HIV Positive Patients After 8 Months on Tenofovir: A Case Study

Tenofovir, a nucleotide reverse transcriptase inhibitor, is a key component of highly active antiretroviral therapy (HAART) for HIV infection. While effective in suppressing viral replication, long-term use of tenofovir has been associated with adverse effects, including bone mineral density (BMD) loss and increased risk of osteopenia and osteoporosis. Tenofovir-induced osteopenia is a significant concern in the management of HIV-infected individuals, as it can lead to increased fracture risk and reduced quality of life.

We present the case of a 40-year-old female patient with HIV who was on a Tenofovir disoproxil fumarate (TDF)-containing regimen consisting ofTenofovir disoproxil fumarate, lamivudine, dolutegravir (TLD) for 8 months and developed symptoms suggestive of osteopenia. The patient presented with difficulty in walking, knee pain and swelling, hip joint pain, and limited left arm mobility, which had significantly impacted her daily activities, leading to her being bedridden for two months. Laboratory findings revealed reduced BMD in the lumbar spine and femoral neck, along with low serum vitamin D levels, supporting the diagnosis of tenofovir-induced osteopenia. The management of tenofovir-induced osteopenia involves discontinuation of TDF and initiation of alternative antiretroviral therapy, as well as supplementation with calcium and vitamin D. In this case, the patient was switched to abacavir, lamivudine, and dolutegravir, which are not associated with significant bone-related side effects. Calcium and vitamin D supplementation were also prescribed to improve bone health. This case highlights the importance of monitoring bone health in patients on TDF therapy and prompt recognition and management of osteopenia to prevent further bone loss and improve quality of life in these patients. Regular assessment of BMD and serum vitamin D levels is essential to detect osteopenia early and initiate appropriate interventions.