Greater decrease in bone mineral density with protease inhibitor regimens compared with nonnucleoside reverse transcriptase inhibitor regimens in HIV-1 infected naive patients

Duvivier, Claudine; Kolta, Sami; Assoumou, Lambert; Ghosn, Jade; Rozenberg, Sylvie; Murphy, Robert L.; Katlama, Christine; Costagliola, Dominique

doi:10.1097/qad.0b013e328328f789

Cited by 221 publications

(188 citation statements)

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“…Some antiretroviral drugs are also known to accelerate osteoporosis. In countries other than Japan, protease inhibitors (PIs) and TDF/FTC have been reported to decrease bone density compared with other types of antiretroviral drugs (10,11). Changes in bone density were not investigated in the present study, but the long-term effects of RAL and ABC/3TC on bone metabolism should be analyzed further among Japanese patients.…”

Section: Discussionmentioning

confidence: 84%

Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naïve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis

et al. 2016

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SUMMARY: Abacavir/lamivudine (ABC/3TC) is a nucleoside reverse transcriptase inhibitor used for treating human immunodeficiency viral (HIV) infections. Hypersensitivity reactions such as skin eruptions caused by ABC are well-known, but rarely occur in Asians. Raltegravir (RAL) is an integrase strand transfer inhibitor, that is now increasingly, used for treating HIV infections because it has few adverse effects. This retrospective analysis assessed the efficacy and safety of combined ABC/3TC and RAL in both treatment-naä ƒve and -experienced Japanese patients with HIV infections. In all 11 treatment-naä ƒve patients (100z), virological suppression to undetectable level was achieved. Liver transaminases, renal function, and serum lipid profiles showed no exacerbations up to 48 weeks of treatment. In 12 patients who were switched from previous regimens to ABC/3TC and RAL, HIV viral load was undetectable in 11 patients (91.6z), but remained detectable in 1 patient with poor adherence. Major reasons for switching regimens to ABC/3TC and RAL were hyperlipidemia and nausea. After switching, these adverse effects improved, and no new adverse effects were observed. Despite the small number of participants in this study, the results support the combination of ABC/3TC and RAL as a possible treatment choice in Japanese individuals with HIV-infection.

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Section: Discussionmentioning

confidence: 84%

Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naïve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis

et al. 2016

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“…We were not able to analyse the potential influence of nonnucleoside reverse transcriptase inhibitors (NNRTIs) as this class was represented in both arms. Randomized studies with NNRTI-sparing arms have shown similar or more pronounced BMD decreases following HAART in this arm compared with the NNRTI-containing arm, which argues against the possibility that the process is driven mainly by NNRTIs [6,17]. …”

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confidence: 99%

Bone mineral density changes in protease inhibitor-sparing vs. nucleoside reverse transcriptase inhibitor-sparing highly active antiretroviral therapy: data from a randomized trial*

et al. 2010

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ObjectiveThe aim of the study was to compare changes in bone mineral density (BMD) over 144 weeks in HIVinfected patients initiating nucleoside reverse transcriptase inhibitor (NRTI)-sparing or protease inhibitor-sparing highly active antiretroviral therapy (HAART). MethodsSixty-three HAART-naïve patients were randomized to zidovudine/lamivudine 1 efavirenz or lopinavir/ritonavir 1 efavirenz. We performed dual energy X-ray absorptiometry (DEXA) at baseline and at weeks 24, 48, 96 and 144 to evaluate lumbar spine and femoral neck (hip) BMD. ResultsAt baseline, 33 patients (55.9%) had low BMD (T-score o À 1.0) and of these eight had osteoporosis (T-score o À 2.5). Spine BMD declined in both arms until week 24, before stabilizing. In the NRTIsparing arm, the mean percentage change from baseline was À 2.7% [95% confidence interval (CI) À 3.9 to À 1.4] at week 24 and À 2.5% (95% CI À 5.4 to 0.3) at week 144, compared with À 3.2% (95% CI À 4.4 to À 2.1) and À 1.9% (95% CI À 3.5 to À 0.3) in the protease inhibitor-sparing arm. Hip BMD declined until week 48 before stabilizing. In the NRTI-sparing arm, BMD had decreased by À 5.1% (95% CI À 7.1 to À 3.1) at week 48 and À 4.5% (95% CI À 6.9 to À 2.1) at week 144, compared with À 6.1% (95% CI À 8.2 to À 4.0) and À 5.0% (95% CI À 6.8 to À 3.1) in the protease inhibitor-sparing arm. There were no significant differences between arms. Low baseline CD4 cell count was independently associated with spine (P 5 0.007) and hip (P 5 0.04) BMD loss and low body mass index with hip BMD loss (P 5 0.03). ConclusionSpine and hip BMD declined rapidly 24 to 48 weeks after initiating HAART, independent of the assigned drug class, but thereafter BMD values remained stable.Keywords: bone mineral density, highly active antiretroviral therapy, HIV, nucleoside reverse transcriptase inhibitors, osteoporosis, protease inhibitors IntroductionThe introduction of highly active antiretroviral therapy (HAART) has altered the morbidity and mortality of HIVinfected patients substantially. Younger persons diagnosed with HIV infection may face more than 30 years of antiretroviral treatment [1], and therefore it has become increasingly important to understand the potential longterm toxicities associated with HAART. Correspondence: Dr Ann-Brit Hansen, Department of Infectious Diseases M5132, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, 2100 Copenhagen, Denmark. Tel: +45 30299306; e-mail: ann-brit.eg. hansen@rh.regionh.dk DOI: 10.1111DOI: 10. /j.1468DOI: 10. -1293DOI: 10. .2010 (2011), 12, 157-165 157.x r 2010 British HIV Association HIV MedicineIt is well documented that the prevalence of osteopenia and osteoporosis is increased in HIV-infected persons. In a recent review it was estimated that up to two-thirds of all HIV-infected patients have reduced bone mineral density (BMD), and 15% have osteoporosis as defined by a T-score of o2.5. Compared with an HIV-negative person, an HIVinfected person is 3-to-4 times more likely to have osteoporosis, and some data indicate that the prevalence...

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“…15 Prospective studies of HIV-infected individuals initiating ART have shown a bone loss of between 2 and 6% in the hip and spine during the first 1-2 years of treatment. [16][17][18][19][20][21][22][23] Tenofovir-containing regimens have consistently been shown to be associated with the greatest bone loss, [20][21][22][23] and in one study the use of PIs was associated with greater bone loss in the spine, 18 although this finding has not been universal. ARTinduced bone loss is accompanied by increases in biochemical markers of bone resorption and formation, implicating increased bone turnover as the mechanism of bone loss.…”

Section: Bmd In Hiv-positive Individualsmentioning

confidence: 80%

HIV infection and osteoporosis

Compston

2015

BoneKEy Reports

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In the past two decades, the life expectancy of people living with HIV infection has increased significantly, and osteoporosis has emerged as a significant comorbidity. In addition to traditional risk factors for fracture, specific factors related to HIV infection are also likely to contribute, including antiretroviral therapy. The heterogeneity of the HIV-infected population in terms of age and ethnicity presents many challenges to the prevention and management of bone disease, and further studies are required to establish optimal approaches to risk assessment and treatment.

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Greater decrease in bone mineral density with protease inhibitor regimens compared with nonnucleoside reverse transcriptase inhibitor regimens in HIV-1 infected naive patients

Cited by 221 publications

References 38 publications

Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naïve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis

Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naïve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis

Bone mineral density changes in protease inhibitor-sparing vs. nucleoside reverse transcriptase inhibitor-sparing highly active antiretroviral therapy: data from a randomized trial*

HIV infection and osteoporosis

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Greater decrease in bone mineral density with protease inhibitor regimens compared with nonnucleoside reverse transcriptase inhibitor regimens in HIV-1 infected naive patients

Cited by 221 publications

References 38 publications

Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Na&iuml;ve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis

Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Na&iuml;ve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis

Bone mineral density changes in protease inhibitor-sparing vs. nucleoside reverse transcriptase inhibitor-sparing highly active antiretroviral therapy: data from a randomized trial*

HIV infection and osteoporosis

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Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naïve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis

Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naïve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis