Bone mineral density changes among people living with HIV who have started with TDF-containing regimen: A five-year prospective study

PLoS One. 2020 Mar 25;15(3):e0230368. doi: 10.1371/journal.pone.0230368. eCollection 2020.


There are limited data regarding long-term BMD changes over time among treatment-naïve people living with HIV (PLHIV) after initiating combined antiretroviral therapy (cART) in Asia. We aimed to study bone mineral density (BMD) changes among treatment-naïve PLHIV started treatment with tenofovir disoproxil fumarate (TDF)- or non-TDF-containing regimen and HIV-uninfected controls in an Asian setting. The study was a five-year prospective study. BMD at lumbar spine (LS) (L1 to L4), total hip (TH), and femoral neck (FN) were measured by dual energy X-ray absorptiometry (DEXA) scans at baseline, months 12, 24 and 60. Multivariate logistic regression models were used to explore factors associated with mean BMD ≥5% reduction after 5 years of cART. A total of 106 PLHIV (75 and 31 started TDF- and non-TDF-containing regimen, respectively) and 66 HIV-uninfected individuals were enrolled. The mean percent changes of BMD were significantly different longitudinally between TDF and non-TDF users (p<0.001 for LS, p = 0.006 for TH and p = 0.02 for FN). HIV-positive status and on TDF-containing regimen was independently associated with BMD loss ≥5% at month 60 (adjusted odds ratio [aOR] 7.0, 95% confidence interval [95%CI] 2.3-21.0, P = 0.001 for LS; aOR 4.9, 95%CI 1.7-14.3, P = 0.003 for TH and aOR 4.3, 95%CI 1.6-11.2, P = 0.003 for FN) compared to HIV-uninfected individuals. In a multivariate model for PLHIV only, TDF use (vs. non-TDF, P = 0.005) and pre-treatment CD4+ count <350 cells/mm3 (vs. ≥350 cells/mm3, P = 0.02) were independently associated with ≥5% BMD loss in TH at month 60. Treatment-naïve PLHIV initiating treatment with TDF-containing regimen have higher BMD loss in a Thai cohort. TDF use and low pre-treatment CD4 count were independently associated with BMD loss at month 60 at TH. Earlier treatment initiation and interventions to prevent bone loss could improve skeletal health among PLHIV. NCT01634607.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Anti-HIV Agents / adverse effects*
  • Bone Density / drug effects*
  • Female
  • Femur Neck
  • HIV Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis / chemically induced
  • Osteoporosis / epidemiology*
  • Osteoporosis / prevention & control
  • Prevalence
  • Prospective Studies
  • Tenofovir / adverse effects*
  • Thailand / epidemiology


  • Anti-HIV Agents
  • Tenofovir

Associated data


Grants and funding

This work was mainly supported by ViiV Healthcare; Thai Red Cross AIDS Research Centre (TRC-ARC); Government research budget 2015–2016 [grant number GRB_APS_12_58_30_09 and GRB_APS_04_59_30_03] and Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University [grant number RA61/008]. All of the sponsors had no role on the study design, data collection, data analysis and the writing of the manuscript.