Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort

Borges, Álvaro H.; Hoy, Jennifer; Florence, Éric; Sedláček, Dalibor; Stellbrink, Hans Jürgen; Uzdaviniene, V.; Tomažič, Janez; Gargalianos‐Kakolyris, Panagiotis; Schmid, Patrick; Orkin, Chloe; Pedersen, Court; Leen, Clifford; Pradier, Christian; Mulcahy, Fiona; Ridolfo, Anna Lisa; Staub, Thérèse; Maltêz, Fernando; Weber, Rainer; Flamholc, Leo; Kyselyova, Galina; Lundgren, Jens D; Mocroft, Amanda; EuroSIDA, for

doi:10.1093/cid/cix167

Cited by 73 publications

(80 citation statements)

References 35 publications

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“…Recently, investigators from EuroSIDA published a study on fractures (n = 496) and osteonecrosis (n = 73, 12 of whom were also included in our study), but when compared with our study, it identified quite a different set of risk factors for AVN: white race, lower nadir CD4, prior fracture/osteonecrosis, and prior AIDS [25]. We found some signal for CD4-nadir in the univariable model but not with AIDS.…”

Section: Discussioncontrasting

confidence: 47%

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Bayard

Ledergerber

Flepp

et al. 2017

Open Forum Infectious Diseases

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BackgroundHIV-infected individuals have an increased risk of avascular bone necrosis (AVN). Antiretroviral therapy (ART) and particularly protease inhibitors (PI) have been implicated as a risk factor. We aimed to study the associations of ART with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS).MethodsWe used incidence density sampling to perform a case control study within the Swiss HIV Cohort Study (SHCS) comparing prospectively collected AVN cases and controls by conditional logistic regression analysis. To evaluate the effect of ART, multivariable models were adjusted for HIV transmission risk group, age, alcohol consumption, use of corticosteroids, CD4 nadir, maximum viral load, and pancreatitis.ResultsWe compared 74 AVN cases and 145 controls. Associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1–10), alcohol consumption (OR, 2.7; 95% CI, 1.3–5.7), and hyperlipidemia (OR, 3.6; 95% CI, 1.4–9.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4; 95% CI, 1.4–14) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN.ConclusionsIn the HIV-infected population, a combination of risk factors such as heterosexual HIV acquisition, moderate to severe alcohol intake, and hyperlipidemia seem to contribute to AVN. ART does not seem to be a relevant risk factor for AVN. The association of prolonged TDF exposure with AVN needs to be confirmed.

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Section: Discussioncontrasting

confidence: 47%

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Bayard

Ledergerber

Flepp

et al. 2017

Open Forum Infectious Diseases

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“…64 During the first 1 to 2 years after initiation of ART, patients may lose 2% to 6% of their bone mineral density at the hip and spine. Patients who receive TDF-containing regimens have a greater initial decline in bone mineral density than those who take a TAF- or abacavir-containing regimen.…”

Section: Recommended Initial Regimensmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Günthard

Saag

Benson

et al. 2016

JAMA

555

313

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“…Similar to CV events, the incidence of trauma fracture appears to be lower in more recent studies and in European populations. For example, the incidence of osteoporotic fracture per 1,000 person-years was reported to be 5.6 in the WIHS, 2.6 in the HIV-positive US veterans, but was only 1.35 in the Swiss HIV cohort (including only validated fractures) [27], and 1.5 in EUROSIDA [28]. …”

Section: Bone Fractures In Hiv – More Than Traditional Risk Factors Amentioning

confidence: 99%

HIV and Aging – Perhaps Not as Dramatic as We Feared?

et al. 2018

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Ever since the introduction of highly active antiretroviral therapy (ART) in 1995, HIV infection has been linked to “metabolic” complications (insulin resistance, dyslipidemia, osteoporosis, and others). Studies suggested increased rates of myocardial infarction, renal insufficiency, neurocognitive dysfunction, and fractures in HIV-postitive patients. Even long-term suppression of HIV seemed to be accompanied by an excess of deleterious inflammation that could promote these complications. The aims of this viewpoint paper are to summarize recent data and to examine the possibility that the problem of aging-related morbidity in HIV might not be as dramatic as previously believed.

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Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort

Abstract: In human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures.

Cited by 73 publications

References 35 publications

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

HIV and Aging – Perhaps Not as Dramatic as We Feared?

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