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and Hepatitis.com Coverage of the
XVIII International AIDS Conference (AIDS 2010) July 18 - 23, 2010, Vienna, Austria
Majority of HIV Positive People on Antiretroviral Therapy May Have Reduced Bone Density
By Liz Highleyman
A considerable body of research has shown that people with HIV have a higher risk of bone problems compared with the general population -- including reduced bone mineral density (osteopenia) and the more advanced bone loss of osteoporosis -- but it has not yet been established whether this is due to HIV infection itself, resulting inflammation, antiretroviral therapy, or some combination of these and other factors.
Anna Bonjoch from University Hospital German Trias in Barcelona and colleagues aimed to determine the prevalence of, and factors associated with, low bone mineral density in HIV positive people.
This retrospective analysis included 671 participants. Most (72%) were men and the median age was 43 years. Almost all of whom were on ART, with an average duration of about 7 years; about half were taking protease inhibitors and about half were on tenofovir (Viread, also in the Truvada and Atripla coformulations).
received at least 1 dual energy X-ray absorptiometry (DEXA) scan and
were included in the cross-sectional analysis. The investigators also
looked at longitudinal changes over time in a subset of 391 patients
who had at least 2 DEXAs during a median 2.5 years of follow-up.
These results, the researchers concluded, "showed a high prevalence of osteopenia and osteoporosis," associated with being male, low BMI, use of protease inhibitors, and duration of protease inhibitors and tenofovir.
"These results demonstrate the high frequency of these abnormalities and the need for an early detection and prevention of them," they added.
In a second AIDS 2010 presentation, Richard Haubrich described changes in bone mineral density among people taking 3 types of antiretroviral regimen. In the open-label ACTG study 5142, a total of 753 treatment-naive participants were randomly allocated in equal numbers to receive the following regimens:
For people assigned to the first 2 regimens, NRTIs were selected prior to randomization and included zidovudine (AZT; Retrovir), stavudine (d4T; Zerit), or tenofovir, all with lamivudine (3TC; Epivir).
About 80% of participants were men, the median age was 38 years, about one-third were white, and the median CD4 count was low, at 190 cells/mm3.
body DEXA was used to assess total body bone mineral density at baseline
(687 patients had baseline measurements available), 48 weeks, and 96
"ART therapy was associated with reductions in bone mineral density, especially in the first year after initiation," the researchers concluded.
"Among the NRTI-containing arms, NRTI selection, especially use of [tenofovir], had a greater effect on bone mineral density change with a non-significant trend for greater declines in the [lopinavir/ritonavir] arm," they continued. "The long-term clinical significance of these bone mineral density changes remains to be determined."
Finally, as previously reported, Veterans Administration researchers presented a study showing that HIV/HCV coinfected people are more likely to sustain fractures due to bone loss than individuals with either virus alone. In this study, however, use of ART had a protective effect.
A Bonjoch, M Figueras, J Puig, and others. Prevalence and associated factors of low bone mineral density in a large cohort of HIV infected patients. XVIII International AIDS Conference (AIDS 2010). Vienna, July 18-23, 2010. Abstract THPDB104.
J Huang, M Hughes, S Riddler, and others. Effects of randomized regimen and nucleoside reverse transcriptase inhibitor (NRTI) selection on 96 week bone mineral density (BMD): results from ACTG 5142. XVIII International AIDS Conference (AIDS 2010). Vienna, July 18-23, 2010. Abstract WEAB0304.