Objective: Although osteopenia is common in HIV-infected patients, there is by now limited data on the evolution of bone mineral density in this population. We aimed to evaluate the course of osteopenia over a 2-year period in HIV-1-infected men, and to identify risk factors for abnormal bone mineral density (BMD) decline.
Methods: HIV-1-infected men on combined antiretroviral therapy (cART) screened in the ANRS 120 Fosivir trial, diagnosed with low BMD (−2.5 ≤T-score <−1), not receiving antiosteoporotic agents, with sequential dual-energy-X ray-absorptiometry (DXA) available at baseline were eligible for this study and had a second DXA performed between months 24 and 36.
Results: We enrolled 94 men with a median age of 46 years [interquartile range (IQR), 41–53], BMI 22 kg/m2 (21–25) and a CD4+ cell nadir of 164/μl (69–261). They were receiving cART for a median of 7.5 years (5.8–9.5). Over a median interval of 2.6 years (2.3–2.9) between the two DXA tests, the mean change in BMD was −0.5 ± 1.7% per year (P = 0.010) at the lumbar spine and −0.4 ± 1.8% per year (P = 0.033) at the hip. BMD fell by more than the smallest detectable difference (SDD) in, respectively, 25.5 and 27.7% of patients at the lumbar spine and hip. Tenofovir (TDF) exposure was independently associated with a larger decline in BMD at both sites [lumbar spine, OR = 2.4 (1.2–4.9); hip, OR = 2.8 (1.3–5.9)].
Conclusion: Although osteopenia overall modestly changes over 2 years in long-term cART-treated patients, a quarter of patients experienced a significant loss (>1 SDD) associated with TDF exposure.
bUPMC Univ Paris 06, UMRS 943
cAP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales
dAP-HP, Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, Paris
eAP-HP, Hôpital Avicenne, Service de maladies infectieuses, Bobigny
fAP-HP, Hôpital Pitié-Salpêtrière, Service de médecines internes
gRheumatology Department, Cochin Hospital, Paris-Descartes University
hAP-HP, Hôpital Pitié-Salpêtrière, Service de Rhumatologie and UPMC Univ Paris 06, Paris, France.
Correspondence to Lambert Assoumou, INSERM U943, 56 Bd V Auriol, BP 335, 75625 Paris Cedex 13, France. Tel: +33(0)1 42 16 42 80; fax: +33(0)1 42 16 42 61; e-mail: firstname.lastname@example.org
Received 19 February, 2013
Revised 17 May, 2013
Accepted 20 May, 2013
These data have been presented in part at the 12th International Workshop on Adverse Drug Reactions and Co-Morbidities in HIV, 4–6 November 2010, London, UK.