HIV; antiretroviral therapy; bone mineral density; bone turnover; renal tubule dysfunction; Anti-HIV Agents; Anti-Retroviral Agents; Biomarkers; Tenofovir; Adult; Aged; Anti-Retroviral Agents/adverse effects; Bone Density; Cross-Sectional Studies; Female; Humans; Kidney; Male; Middle Aged; Tenofovir/adverse effects; Anti-HIV Agents/adverse effects; HIV Infections/complications; HIV Infections; Pharmacology; Pharmacology (medical); Infectious Diseases
Abstract :
[en] [en] BACKGROUND: Data on low bone mineral density (BMD) in people living with HIV (PLWH) are mainly derived from younger adults; little is known about how antiretroviral therapy (ART) and alterations in the renal-bone axis relate to BMD in older PLWH.
METHODS: Cross-sectional study of men > 50 years and post-menopausal women with HIV. Antiretroviral therapy exposure was stratified into four groups based on use of tenofovir disoproxil fumarate (TDF) and protease inhibitors (PI): non-TDF/non-PI, non-TDF/PI, TDF/non-PI, and TDF/PI. Bone mineral density was measured by dual X-ray absorptiometry (DXA). Bone turnover/regulatory markers and renal tubular function were analysed in stored plasma and urine samples. The association of ART exposure and bone/renal biomarkers on BMD was explored using logistic regression models.
RESULTS: 247 individuals (median [IQR] age 57 [53, 65] years; 47% female; 13% of Black ethnicity; CD4 count 643 [473, 811] cells/mm3; and 98% with HIV RNA < 200 copies/mL) were included. Bone turnover and renal tubular function differed significantly by ART exposure. In analyses adjusted for demographic and traditional renal/bone risk factors, exposure to TDF and PI was associated with a fourfold greater risk of low BMD at the femoral neck and exposure to TDF and/or PI with a threefold greater risk of low BMD at the lumbar spine. The relationship between ART and low BMD was not altered by further adjustment for bone turnover or renal tubular function markers.
CONCLUSIONS: The associations between low BMD and ART exposure (TDF vs. non-TDF and boosted vs. unboosted third agents) were minimally affected by adjustments for bone and kidney biomarkers.
Disciplines :
Immunology & infectious disease
Author, co-author :
Alvarez, Elena ; Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
Campbell, Lucy; 4616Kings College London, London, UK
Tinago, Willard; Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
Garcia-Leon, Alejandro; Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
Walsh, Ian; 8881Mater Misericordiae University Hospital, Dublin, Ireland
Brady, Jennifer J; 8881Mater Misericordiae University Hospital, Dublin, Ireland
Burling, Keith; 2152Cambridge University, Cambridge, UK
Noe, Sebastian; MVZ Karlsplatz HIV Research and Clinical Care Center, Munich, Germany
Neuville, Marie F; Laboratory of Translational Research in Nephrology, ULiege GIGA Research Center, Liege, Belgium
Jouret, François ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
Jamshidian, Farid; 2158Gilead Sciences, Inc., Foster City, CA, USA
Graham, Hiba; 2158Gilead Sciences, Inc., Foster City, CA, USA
Rhee, Martin; 2158Gilead Sciences, Inc., Foster City, CA, USA
Mallon, Paddy W; Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
Post, Frank A; 4616Kings College London, London, UK ; 8948King's College Hospital NHS Foundation Trust, London, UK
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The present work was supported by Gilead Sciences (CO-UK-311-187).
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