Timing, Dosage, and Adherence of Antiretroviral Therapy and Risk of Osteoporosis in Patients With Human Immunodeficiency Virus Infection in Taiwan: A Nested Case-Control Study

Abstract

The progression of acquired immunodeficiency syndrome is delayed in patients with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy (ART). However, long-term ART is associated with adverse effects. Osteoporosis is one of the adverse effects and is a multifactorial systemic skeletal disease associated with bone fragility and an increased risk of fracture. We performed a longitudinal, comprehensive, nested case-control study to explore the effect of ART on the risk of osteoporosis in 104 osteoporotic and 416 non-osteoporotic patients with HIV infection at their average age about 29 years old in Taiwan. Patients with history of ART, current exposure to ART, higher cumulative defined daily doses (DDDs), or higher ART adherence were at a higher risk of osteoporosis (p < 0.05). Patients receiving nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-containing regimen (zidovudine-lamivudine combination, lamivudine-abacavir combination, and abacavir alone) and protease inhibitor (PI)-containing regimen (lopinavir-ritonavir combination, ritonavir, and atazanavir) had a higher risk of osteoporosis (p < 0.05). Especially, patients receiving high doses of the PIs lopinavir-ritonavir combination had an increased risk of osteoporosis (p < 0.05). In conclusion, history of ART, current exposure to ART, higher cumulative DDDs, and higher ART adherence were associated with an increased risk of osteoporosis. Furthermore, NRTI- and PI-containing regimens and high doses of PIs lopinavir-ritonavir combination may be associated with an increased risk of osteoporosis in patients with HIV infection in Taiwan.

Lopinavir-menthol co-crystals for enhanced dissolution rate and intestinal absorption

“…Lopinavir is a protease inhibitor that has been widely used for many years as therapy for human immunodeficiency virus (HIV) infection in both adults and children. As antiretroviral therapy, lopinavir effectively inhibits viral replication and offers a higher quality of life for the patients [ [1] , [2] , [3] , [4] ]. Lopinavir is also used as a prophylactic treatment for pregnant HIV-mothers to protect their neonates [ 5 , 6 ].…”

Unilateral avascular necrosis of the right hip in an HIV patient with tearing of the rectus femoris and adductor longus muscles

“…Three nucleoside reverse transcriptase inhibitors (NRTIs)—zidovudine-lamivudine combination, lamivudine-abacavir combination, and abacavir—and three protease inhibitors (PIs)—lopinavir-ritonavir combination, ritonavir and atazanavir—were associated with an increased risk of osteoporosis. 13 …”

Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study

“…This study included the following antiretroviral therapy (ART) drugs: 1) nucleoside/nucleotide reverse-transcriptase inhibitor (NRTI), Anatomical Therapeutic Chemical (ATC) code: J05AF01, J05AF04, J05AF02, J05AF03, J05AF05, J05AF06, and J05AF07; 2) non-nucleoside reverse-transcriptase inhibitor (NNRTI), ATC code: J05AG01, J05AG04, J05AG03, and J05AG05; 3) protease inhibitor (PI), ATC code: J05AE01, J05AE04, J05AE02, J05AE03, J05AE08, J05AE09, and J05AE10; 4) integrase strand transfer inhibitor (INSTI), ATC code: J05AX09, J05AX07, J05AX08, and J05AX12; and 5) combinations of over two ART drugs per tablet, ATC code: J05AR01, J05AR03, J05AR02, J05AR04, J05AR05, J05AR06, J05AR08, J05AR10, J05AR13, J05AR14, J05AR18, J05AR19, J05AR20, J05AR21, J05AR22, and J05AR25 ( Chiu et al, 2021 ).…”

“…The viral genome integrates into the human genome in circulatory immune T cells and serves as an HIV reservoir in patients treated with ART ( Warren et al, 2020 ). Furthermore, long-term cART treatment is associated with adverse effects, including hyperlipidemia ( Tsai et al, 2017a ), cardiovascular disease ( Dorjee et al, 2017 ), bone loss ( Hoy et al, 2017 ; Chiu et al, 2021 ), and neurocognitive impairment ( Yuan and Kaul, 2021 ).…”