Grund B, Peng G, Gibert CL, Hoy JF, Isaksson RL, Shlay JC, Martinez E, Reiss P, Visnegarwala F, Carr AD, INSIGHT SMART Body Composition Substudy Group. Continuous antiretroviral therapy decreases bone mineral density.
AIDS 2009;
23:1519-29. [PMID:
19531929 PMCID:
PMC2748675 DOI:
10.1097/qad.0b013e32832c1792]
[Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Collaborators] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES
To assess the effects of antiretroviral therapy (ART) on bone mineral density (BMD) DESIGN: Randomized comparison of continuous ART (viral suppression group; VS) with intermittent ART (drug conservation group; DC) SETTING: Outpatient clinics in the United States, Australia, and Spain.
PARTICIPANTS
Participants in the Strategies for Management of Antiretroviral Therapy (SMART) Body Composition substudy.
MAIN OUTCOME MEASURES
Annual hip and spine BMD by dual-energy radiographic absorptiometry (DXA) and spine BMD by quantitative computed tomography (qCT).
METHODS
Comparisons were by intention-to-treat analysis, using longitudinal models for change in BMD. Risk factors for BMD loss were evaluated.
RESULTS
The 214 participants (median 44 years, 19% female participants, 73% on ART; median T-scores -0.5 total hip, -0.7 spine DXA, -0.9 spine qCT; 98 randomized to VS and 116 to DC) were followed for a mean 2.4 years. With continuous ART, BMD declined per year by 0.8% (hip), 0.4% (spine DXA), and 2.4% (spine qCT). BMD declined significantly less with intermittent ART. Estimated DC minus VS group differences in mean BMD change through follow-up were 1.4% [hip; 95% confidence interval (CI) 0.6-2.3; P = 0.002], 1.3% (spine DXA; 95% CI 0.1-2.4, P = 0.03), and 3.0% (spine qCT; 95% CI 0.8-5.2, P = 0.007). No consistent drug-specific association with BMD decline was found. In the parent study, 10 of 2753 participants in the VS group and two of 2720 in the DC group reported serious fractures (hazard ratio 4.9; 95% CI 1.1-22.5; P = 0.04).
CONCLUSION
Continuous ART is associated with decline in BMD and possibly more fractures relative to intermittent, CD4 cell count-guided ART.
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Collaborators
Estela A Acosta, Roberto C Arduino, Jorge Darcourt Riso-Patron, Carmen Machado, Pablo C Okhuysen, Maria C Rodriguez-Barradas, Maria Tadea Insignares, A Clinton White, Diana Antoniskis, Doug Beers, David Gilbert, Joel Godbey, Gordon Johnson, Todd Korthuis, James Leggett, Michael McVeigh, Melinda Mueller, Mary O'Hearn, James Sampson, Jonathan Anderson, Kathy Barnes, Alison Cain, David Cooper, Beng Eu, Martyn French, Jennifer Hoy, Nic Medland, Richard Moore, Sally Price, Norm Roth, Jega Sarangapany, Don Smith, Bak Kiem Tee, Susan Caras, Rosetta Contreras, John Corser, Livette Johnson, Subha Raghavan, Helen May Seedhom, Maria Larrousse, Sergi Vidal, Robert Brennan, Vivian Bruzzese, Anne Chiang, Clarence Childress, Carol Clark, Patricia Dodson, Kathleen Genther, Robert Higginson, Jane Kaatz, Johanna McKee, Daniel Nixon, Jane Settle, Vicky Watson, Joy Zeh, Isabel Vecino, Stephen E Weis, Suzanne L Adams, Sue Pabolvich, Connie Z Scott, Janice Y Walker,
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