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AIDS. 2018 Nov 13;32(17):2517-2524. doi: 10.1097/QAD.0000000000001995.

Women have enhanced bone loss associated with phosphaturia and CD4+ cell restoration during initial antiretroviral therapy.

Author information

1
Department of Medicine, MetroHealth Medical Center.
2
Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Administration Medical Center.
3
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.
4
Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York.
5
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
6
Department of Pediatrics and Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
7
HIV Research Branch, Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland.
8
Division of Infectious Diseases, Department of Medicine, University of Cincinnati, Cincinnati, Ohio.
9
Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland.
10
Division of Infectious Diseases, Northwestern University, Chicago, Illinois, USA.

Abstract

OBJECTIVE:

We compared bone mineral density (BMD) changes and their correlates, between men and women participating in two randomized trials of initial [antiretroviral therapy (ART)] regimens, with or without tenofovir disoproxil fumarate (TDF).

METHODS:

Covariates in linear regression models of 48-week hip and spine %BMD changes, by dual energy X-ray absorptiometry, included baseline and 48-week changes in plasma viral load, CD4 cells, plasma C-terminal telopeptide, procollagen 1 N-terminal propeptide and glomerular filtration rates, and the 48-week area under the curve of fractional excretion of phosphate.

RESULTS:

Despite overall hip and spine BMD declines of 2.8 and 2.9%, respectively, plasma viral load suppression to less than 50 vs. at least 50 copies/ml was associated 1.0% (P = 0.02) and 0.8% (P = 0.01) less BMD decline. Women had lower baseline spine (P = 0.04; n = 59 women, 418 men) and hip BMD (P = 0.01) in adjusted models, with 1.7% more hip decline on ART than men (P = 0.001). Serum phosphate was positively associated with baseline spine BMD in women (P = 0.03) but not men, and area under the curve of fractional excretion of phosphate was negatively associated with spine BMD changes, particularly in women randomized to TDF regimens (P = 0.03 and 0.054 for interactions by sex, and randomization to TDF vs. non-TDF regimens, respectively; n = 44 women, 326 men). Women also had 0.6% (P = 0.004) more hip BMD decline than men associated with each 100 CD4 cells/μl increase on ART (P = 0.02; n = 49 women, 379 men).

CONCLUSION:

Women randomized to TDF-containing ART had accentuated spine loss associated with phosphaturia, and accentuated hip loss associated with CD4 restoration, regardless of TDF exposure. Viral load suppression reduced bone loss.

PMID:
30134291
PMCID:
PMC6230267
DOI:
10.1097/QAD.0000000000001995
[Indexed for MEDLINE]
Free PMC Article

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