Persistently elevated alkaline phosphatase could be related to Paget's disease of bone in a patient receiving tenofovir disoproxil fumarate.

This article focuses on a rare case of Paget's disease of bone (PDB) in a person with HIV (PWH) receiving tenofovir disoproxil fumarate (DF)-based combined antiretroviral therapy (cART). PDB is a metabolic bone disorder characterized by increased bone turnover and deformity, typically affecting adults over 55 years old, but its occurrence in PWH is scarcely reported. The case describes a 67-year-old HIV-positive man with persistently elevated alkaline phosphatase (AP) levels despite discontinuation of tenofovir DF, leading to a diagnosis of PDB confirmed by imaging. The report highlights that while tenofovir DF can cause reversible AP increases due to kidney tubular effects, persistent AP elevation without other renal abnormalities in older PWH should prompt consideration of PDB.