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Quantitative Structure-Activity Relationship, Activity Prediction, and Molecular Dynamics of Non-nucleotide Reverse Transcriptase Inhibitors
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Greater decrease in bone mineral density with protease inhibitor regimens compared with nonnucleoside reverse

Claudine Duvivier1, Sami Kolta, Lambert Assoumou

  • 1AP-HP, Groupe hospitalier Pitié Salpétrière, Service de Maladies Infectieuses et Tropicales, Paris, France.

AIDS (London, England)
|April 14, 2009
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Summary

Antiretroviral therapy can decrease bone mineral density (BMD), particularly at the lumbar spine. Monitoring BMD is crucial during treatment with protease inhibitor-containing regimens compared to non-nucleoside reverse transcriptase inhibitors.

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Last Updated: Jun 24, 2026

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Area of Science:

  • Bone Metabolism and HIV
  • Pharmacology of Antiretroviral Drugs

Background:

  • Bone mineral density (BMD) impairment affects a significant portion of patients before initiating antiretroviral therapy (ART).
  • Understanding the impact of different ART regimens on BMD is crucial for long-term patient management.

Purpose of the Study:

  • To assess changes in BMD at the hip and lumbar spine in HIV-infected patients starting ART.
  • To compare the effects of different ART strategies on BMD.

Main Methods:

  • A substudy of the ANRS 121 trial randomized 71 antiretroviral-naive patients into three arms: NNRTI + PI/r, PI/r + NRTIs, or NNRTI + NRTIs.
  • BMD was measured at baseline and 48 weeks using dual X-ray absorptiometry.

Main Results:

  • A mean decrease in BMD of -4.1% at the lumbar spine and -2.8% at the hip was observed after 48 weeks (P<0.001).
  • Lumbar spine BMD loss was significantly greater in patients on PI/r-containing regimens (-4.4% to -5.8%) compared to NNRTI + NRTIs (-1.5%).

Conclusions:

  • A substantial percentage of patients (34%) had impaired BMD prior to ART initiation.
  • PI/r-containing ART regimens were associated with more pronounced lumbar spine BMD loss compared to NNRTI + NRTIs.
  • Regular BMD monitoring is recommended for patients on long-term ART.