Evolution of bone mineral density in AIDS patients on treatment with zidovudine/lamivudine plus abacavir or lopinavir/ritonavir

Abstract

ObjectivesThe aim of the study was to determine the factors that may contribute to decreases in bone mineral density (BMD) in patients with AIDS. MethodsThis was a prospective, non-randomized study. Dual X-ray absorptiometry (DXA) was used to determine the BMD of the lumbar spine, femoral neck and distal radius in treatment-naïve HIV-infected male patients with AIDS before and after 1 year of treatment with zidovudine (ZDV)/lamivudine (3TC) plus abacavir (ABC) or lopinavir/ritonavir (LPV/r). ResultsBasal DXA was performed in 50 patients with CD4 counts o200 cells/mL and/or any AIDS-defining condition. Thirty-two patients completed 1 year with full adherence (17 on ABC and 15 on LPV/r) and a second DXA was then performed. At baseline, 19% had osteopenia at the lumbar spine and 19% at the femoral neck. Low body weight was related to low BMD. After 48 weeks, BMD loss was significant at the three locations. The percentage of BMD loss at the femoral neck tended to be greater in the lopinavir group (5.3 vs. 3.2%, P 5 0.058). The differences became significant at the lumbar spine (5.7 vs. 2.7%, P 5 0.044). In the multivariate analysis, the treatment with LPV/r remained associated with bone loss at the lumbar spine. ConclusionsOsteopenia is frequent in treatment-naïve HIV-infected men with AIDS. Bone loss is higher with LPV/r-based regimens compared with triple nucleoside reverse transcriptase inhibitors.

WNT/β-Catenin Signaling Is Involved in Regulation of Osteoclast Differentiation by Human Immunodeficiency Virus Protease Inhibitor Ritonavir

“…The former was associated with significant loss of BMD. 46 Furthermore, using an autologous serum OC induction assay, by which OC differentiation is quantitated in patient adherent cells cultured for 7 days only in the presence of 15% autologous serum, we found higher levels of OC formation in HIV ϩ , RTV-treated patients (n ϭ 8) versus HIV ϩ patients taking other antiretrovirals (n ϭ 32; P Ͻ 0.02). 20 This held true irrespective of a patient's estimated duration of HIV infection or current CD4…”

“…These results are consistent with the effects of RTV and IFN-␥ in our in vitro models of OC differentiation, 9 and parallel preliminary clinical observations of BMD loss in RTV-treated HIV ϩ patients. 5,20,45,46 For example, we have an ongoing study assessing the impact of RTVbased ART versus other forms of anti-HIV therapy on bone mineralization in HIV ϩ versus HIV Ϫ postmenopausal women. Interim analysis showed higher levels of the three main peripheral markers for bone turnover, bone-specific alkaline phosphatase, osteocalcin, and Ntelopeptide (P values from 0.02 to 0.004), as well as BMD, assessed by dual-energy X-ray absorptiometry of the total hip (P Ͻ 0.01) in RTV-treated versus treatmentnaive HIV ϩ patients, and a trend for a decrease in total hip BMD for HIV ϩ /RTV-treated patients versus those on other ART regimens (P ϭ 0.12).…”

Evaluation of bone alterations in the jaws of HIV-infected menopausal women

“…Furthermore, protease inhibitors are known osteopenic agents; however, a more consistent link between this group of drugs and bone loss remains to be proven. [4][5][6][25][26][27][28] Panoramic radiography can be considered an auxiliary tool for dentists in the detection of possible alterations and bone fractures in the jaw, especially in postmenopausal women. 13,14,29 Measurements of MI, PMI, and AD have already been used and have been validated in the scientific literature.…”

Changes in Bone Mineral Density After 96 Weeks of Treatment With Atazanavir/Ritonavir or Lopinavir/Ritonavir Plus Tenofovir DF/Emtricitabine in Treatment-Naive Patients With HIV-1 Infection

“…Bone disease is likely to become an increasingly important comorbidity in the aging HIV population. [1][2][3][4][5][6][7][8][9] A meta-analysis of cross-sectional studies using dual-energy x-ray absorptiometry (DXA) to measure bone mineral density (BMD) demonstrated pooled odds ratios of 6.4 for reduced BMD and 3.7 for osteoporosis in HIV-infected vs non-HIV-infected patients. 2 A large population-based study in a US health-care system showed that overall fracture prevalence was 2.87% in HIVinfected patients compared with 1.77% in non-HIV-infected patients.…”