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ARTICLES:
Rachel I. Gafni, Rohan Hazra, James C. Reynolds, Frank Maldarelli, Antonella N. Tullio, Ellen DeCarlo, Carol J. Worrell, John F. Flaherty, Kitty Yale, Brian P. Kearney, and Steven L. Zeichner
Tenofovir Disoproxil Fumarate and an Optimized Background Regimen of Antiretroviral Agents as Salvage Therapy: Impact on Bone Mineral Density in HIV-Infected Children
Pediatrics 2006; 118: e711-e718 [Abstract] [Full text] [PDF]
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[Read eLetters] Tenofovir and bone mineral density
Anne Sutcliffe   (22 January 2007)

Tenofovir and bone mineral density 22 January 2007
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Anne Sutcliffe,
Editor
Australian Medicines Handbook

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Re: Tenofovir and bone mineral density

anne{at}amh.net.au Anne Sutcliffe

Dear Sir

I read with interest the article by Gafni et al(1) regarding the influence of tenofovir on bone mineral density in children. The authors stated that the children were not treated long term with medications that might affect bone and that the corticosteroids used were unlikely to have been the primary cause of the observed bone loss. However, some children were taking ritonavir and fluticasone and there is no information as to length of concurrent treatment. Ritonavir can increase the concentration of fluticasone such that systemic effects have been observed(2,3,4) and I wondered what influence this may have had on these children’s results.

Yours sincerely

Anne Sutcliffe BSc, BPharm

Editor

Australian Medicines Handbook

Adelaide, South Australia

1. Gafni RI et al. Pediatrics 2006;118:e711–718.

2. Gupta SK and Dube MP. Exogenous Cushing syndrome mimicking human immunodeficiency virus lipodystrophy. Clin Inf Dis 2002;35:e69–e71.

3. Clevenbergh P et al. Iatrogenic Cushing’s syndrome in an HIV- infected patient treated with inhaled corticosteroids (fluticasone propionate) and low dose ritonavir enhanced PI containing regimen. J Infect 2002;44:194–195.

4. Arrington-Sanders R, Hutton N and Siberry GK. Ritonavir- fluticasone interaction causing Cushing syndrome in HIV-infected children and adolescents. Pediatr Infect Dis J 2006;25:1044–1048.

Conflict of Interest:

None declared