HIV and Bone Complications: Understudied Populations and New Management Strategies

Yin, Michael T.; Brown, Todd T.

doi:10.1007/s11904-016-0341-9

Cited by 22 publications

(19 citation statements)

References 81 publications

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“…Youth who acquire HIV, on the other hand, face the BMD effects of HIV itself and lifelong treatment with medications that may also decrease their BMD. Fortunately, there is also evidence that the effect of TDF on BMD in PrEP users is reversible, with the greatest recovery among young participants under 25 years old [20]. The CDC and WHO do not currently recommend DXA scans for otherwise healthy individuals on PrEP [3, 4*].…”

Section: Tolerability and Safety Of Prepmentioning

confidence: 99%

HIV preexposure prophylaxis for adolescents and young adults

Allen

Gordon

Krakower

et al. 2017

Current Opinion in Pediatrics

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STRUCTURED ABSTRACT Purpose of review This review describes the evidence for HIV pre-exposure prophylaxis (PrEP) with daily combined tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) in adolescents and young adults. Current recommendations are described, as are the unique medical, socioeconomic, and legal considerations regarding the use of PrEP for youth. Recent findings PrEP with daily oral TDF-FTC has been shown to help prevent new HIV infection among adults at substantial risk. Evidence suggests a protective benefit of PrEP for youth at risk for HIV, although low adherence is emerging as a barrier to effective use. Summary Effective use of antiretrovirals for PrEP represents a seminal development in HIV prevention efforts. Improving access and adherence to PrEP for youth has the potential to substantially reduce the incidence of HIV in this population.

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Section: Tolerability and Safety Of Prepmentioning

confidence: 99%

HIV preexposure prophylaxis for adolescents and young adults

Allen

Gordon

Krakower

et al. 2017

Current Opinion in Pediatrics

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“…These risk factors are also established for osteoporosis and osteoporotic fractures [18, 19], which hints toward a potential similarity of risk factors for AVN and osteoporosis in HIV-seropositive persons. We did not find evidence for an association of AVN with any ART exposure except for a TDF signal.…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged use of ART, particularly exposure to protease inhibitors, has also been implicated as a potential AVN risk factor, possibly via PI-aggravated dyslipidemia (especially hypertriglyceridemia) and impaired circulation [18, 19]. A recently published meta-analysis [18, 19] on 68 AVN cases and 126 controls showed an increased odds ratio for AVN among PI-exposed HIV-infected patients.…”

Section: Discussionmentioning

confidence: 99%

“…A recently published meta-analysis [18, 19] on 68 AVN cases and 126 controls showed an increased odds ratio for AVN among PI-exposed HIV-infected patients. In contrast to this meta-analysis, we did not find an association with any PI except for a weak ATV (ATV > 1 year: OR, 2.4; 95% CI, 0.86–6.4) and NFV signal (NVF ever vs never use, 2.4: 95% CI, 0.86–6.4).…”

Section: Discussionmentioning

confidence: 99%

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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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“…19 TDF-based PrEP studies may be underpowered to detect fracture outcomes given the generally younger, healthier populations enrolled in PrEP trials, leading to the use of BMD as a surrogate. 15,20 Peak bone mass is established in young adulthood and is a strong predictor of fracture risk later in life. 17,21 TDF-based PrEP has been recently approved for adolescents >35 kg.…”

Section: Introductionmentioning

confidence: 99%

Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project

Spinelli

Glidden

Anderson

et al. 2019

AIDS Research and Human Retroviruses

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Bone mineral density (BMD) declines due to tenofovir-containing pre-exposure prophylaxis (PrEP) have varied among PrEP demonstration projects, potentially related to variable adherence. Characterization of BMD changes in highly adherent individuals, estimated via tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS), can assist clinicians when counseling patients. Cisgender men who have sex with men and transwomen in the optional dual-energy X-ray absorptiometry (DXA) substudy of a large, international, openlabel PrEP demonstration project, the iPrEx-open-label extension (OLE) study underwent DXA scans and DBS collection every 24 weeks, with average weekly dosing adherence patterns (2, 4, and 7 doses/week) estimated from validated TFV-DP cutoffs. The mean percent BMD change was estimated in strata of average weekly adherence by using a linear mixed-effects model to calculate the BMD decline in highly adherent individuals on PrEP for the first time. DXA/DBS data were available for 254 individuals over a median of 24 weeks in iPrEx-OLE from June 2011 to December 2013. The percent decline in spine BMD was monotonically associated with strata of increasing average weekly adherence (p < .001 trend); the p value for trends using hip BMD measurements was .07. Individuals with estimated daily adherence experienced a 1.2% decrease in spine BMD and a 0.5% drop in hip BMD. In highly adherent PrEP users, we found a lower-than-expected drop in BMD when compared with previous studies. This drop is likely not clinically significant for most PrEP users. However, for those at the highest risk of fracture who plan prolonged PrEP use, alternate PrEP strategies could be considered.

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HIV and Bone Complications: Understudied Populations and New Management Strategies

Cited by 22 publications

References 81 publications

HIV preexposure prophylaxis for adolescents and young adults

HIV preexposure prophylaxis for adolescents and young adults

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

Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project

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