BMD Correlates with Number of HIV Regimens (CME/CE)
The number of HIV treatment regimens a patient undergoes appears to correlate with loss of bone mineral density (BMD), researchers reported here at the International Aids Society Conference on HIV Pathogenesis, Treatment, and Prevention.
In the multivariate analysis involving 210 patients with HIV infection, the parameter estimate for BMD loss at the femoral neck was -0.011 g/cm2 for each regimen a patient had taken (95% CI minus 0.022-minus 0.0003, P
=0.05), reported Aoife Cotter, MD, a fellow in infectious diseases at University College Dublin.
"Unexpectedly, we did not find that current use of or cumulative exposure to antiretrovirals, antiretroviral class, or specific antiretroviral agents independently predicted lower bone mineral density," Cotter told MedPage Today
at her poster presentation.
In addition to the multivariate analysis finding of lower BMD at the femoral neck, Cotter and colleagues also noted that the lumbar spine BMD loss was also associated with the number of HIV regimens. At the lumbar spine there was a loss of 0.015 g/cm2 (P
=0.03), she reported.
Cotter reviewed data in the prospective HIV UPBEAT (Understanding the Pathology of Bone Disease in HIV-infected Subjects) which enrolled HIV-positive and HIV-negative participants from similar demographic backgrounds. The median age of the HIV-infected patients was 39, mean BMI was 26 kg/m2, 58.6% were men, 60.5% were Caucasians, 39.5% were of African ethnicity, 34.8% were current smokers.
Cotter said the researchers considered that the number of HIV regimens might be a surrogate measure for time with HIV infection, but in performing the multivariate analysis they did not find a correlation that was statistically significant.
"We suggest that these findings are consistent with data demonstrating greater reductions in bone mineral density associated with antiretroviral-induced HIV suppression occurring with multiple antiretroviral regimens," she said.
In the multivariate analysis, the researchers did not see a significant difference in bone mineral density loss when comparing injecting drug users with non-injecting drug users with HIV infection (P
=0.54); with baseline CD4-positive T-cell counts- (P=0.21); with nadir CD4 cell counts (P=0.09); duration since HIV diagnosis (P=0.86); cumulative antiretroviral exposure (P=0.40); cumulative nucleoside reverse transcriptase inhibitor exposure (P=0.41); cumulative tenofovir exposure (P=0.34); cumulative non-nucleoside reverse transcriptase inhibitor exposure (P=0.63), or cumulative protease inhibitor exposure (P=0.11).
In commenting on the study, Ian Woolley, MBBS, professor of medicine at Monash University in Melbourne, Australia, told MedPage Today,
"The number of HIV regimens may be a surrogate for lack of adherence by these patients."
He added, "There are usually two reasons why patients change regimens. It is because of resistance or because of toxicity. It is also possible there is a phenotype that is more likely to develop toxicity."
