Serum Levels of Fibroblast Growth Factor 23 in People Living with HIV

Abstract

Background: Fibroblast growth factor (FGF) 23 is a well-known phosphaturic hormone produced mainly by bone cells to maintain phosphate and mineral homeostasis. Serum FGF23 levels are elevated in patients with chronic kidney disease (CKD), and elevated FGF23 might increase the risk of cardiovascular disease (CVD). Several reports have documented an increased incidence of risk factors for osteopenia, CKD, and CVD in people living with HIV (PLWH). However, few reports related to FGF23 in PLWH have been published. Methods: Male HIV patients who presented to the outpatient clinic of Teikyo University Hospital, Tokyo, Japan, in 2015 and were treated with antiretroviral therapy (ART) for > 6 months were enrolled in the study. In addition to serum FGF23 measurements, the clinical factors assessed included age, ART regimens, and laboratory data. Spearman correlation and multiple regression analysis were performed to determine factors significantly associated with FGF23. Results: In total, 67 patients were enrolled in the present study. The median age was 43.7 years, the median CD4 count was 529 cells/μL, and the median serum FGF23 level was 36.0 pg/mL. Based on correlation and multiple regression analyses, serum FGF23 levels were significantly correlated with HIV RNA > 50 copies (correlation analysis: t = 3.4259, P = 0.0011 / multiple regression analysis: P = 0.00106) or abacavir (ABC)/lamivudine (3TC) use (t = 2.8618, P = 0.0057 / P = 0.02704). Conclusions: Factors significantly associated with elevated serum FGF23 levels included poor virologic control and ABC/3TC use.

Biomarkers to predict cardiovascular disease in people living with HIV

“…Yoshino et al [30] measured FGF23 in 67 men with HIV on ART and examined factors associated with its production. Interestingly, they found the higher FGF 23 was associated with both a HIV RNA more than 50 copies/ml and current use of the nucleoside reverse transcriptase inhibitor (NRTI), abacavir (ABC) [30]. Given observational data linking increased CVD risk with both HIV viremia and ABC use, further work is needed to confirm any association between FGF23 and CVD risk in PWH in appropriately adjusted analyses, particularly accounting for the confounding effect of potential preferential choice of abacavir in the setting of CKD.…”

“…In the general population, it also has been associated with many CVDrelated conditions, including hypertension, left ventricular hypertrophy and in some studies, subclinical CVD [24][25][26][27][28][29]. Yoshino et al [30] measured FGF23 in 67 men with HIV on ART and examined factors associated with its production. Interestingly, they found the higher FGF 23 was associated with both a HIV RNA more than 50 copies/ml and current use of the nucleoside reverse transcriptase inhibitor (NRTI), abacavir (ABC) [30].…”