Format

Send to

Choose Destination
AIDS. 2018 Sep 10;32(14):1967-1975. doi: 10.1097/QAD.0000000000001911.

Zoledronic acid is superior to tenofovir disoproxil fumarate-switching for low bone mineral density in adults with HIV.

Author information

1
Alfred Hospital and Monash University, Melbourne.
2
St Vincent's Hospital, Sydney.
3
Monash University, Melbourne, Australia.
4
Hospital Clinic, University of Barcelona, Barcelona, Spain.
5
Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Abstract

OBJECTIVE:

To compare the effects of switching tenofovir disoproxil fumarate (TDF) or treatment with an intravenous bisphosphonate on bone mineral density (BMD) in HIV-positive adults with low bone mass.

DESIGN:

Two-year, randomized, open-label study at 10 sites in Australia and Spain.

PARTICIPANTS:

Of 112 adults on TDF-based antiretroviral therapy (ART) screened, 87 with low BMD (T-score < -1.0 at hip or spine by dual-energy X-ray absorptiometry) and undetectable plasma HIV viral load were randomized to either switch TDF to another active antiretroviral drug or to continue TDF-based ART and receive intravenous zoledronic acid (ZOL) 5 mg annually for 2 years.

PRIMARY OUTCOME MEASURE:

Change in lumbar spine BMD at 24 months by intention-to-treat analysis. Secondary outcomes included changes in femoral neck and total hip BMD, fractures, safety, and virological failure.

RESULTS:

Forty-four participants were randomized to TDF switch and 43 to ZOL, mean age 50 years (SD 11), 96% men, mean TDF duration 5.9 years (SD 3.1), and mean spine and hip T-scores -1.6 and -1.3, respectively. At 24 months, mean spine BMD increased by 7.4% (SD 4.3%) with ZOL vs. 2.9% (SD 4.5%) with TDF-switch (mean difference 4.4%, 95% CI 2.6-6.3; P < 0.001). Mean total hip BMD increased by 4.6 (SD 2.6%) and 2.6% (SD 4%), respectively (mean difference 1.9%, 95% CI 0.5-3.4; P = 0.009). There was one fracture in the ZOL group vs. seven fractures in four TDF-switch participants. Virological failure occurred in one TDF-switch participant. Other safety endpoints were similar.

CONCLUSION:

ZOL is more effective than switching TDF at increasing BMD in HIV-positive adults with low bone mass.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center