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.

Abstract

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. Clinicaltrials.gov: 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

Substances

  • Anti-HIV Agents
  • Tenofovir

Associated data

  • ClinicalTrials.gov/NCT01634607

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.