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Published on: July 24, 2013
Fractures after antiretroviral initiation
Michael T Yin1, Michelle A Kendall, Xingye Wu
1Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA. Mty4@columbia.edu
AIDS (London, England)
|September 7, 2012
Summary
Fracture rates in HIV patients are higher in the first two years of antiretroviral therapy (ART). However, continued ART use does not increase fracture risk in younger individuals.
Area of Science:
- HIV/AIDS research
- Bone health in infectious diseases
- Clinical pharmacology
Background:
- Bone mineral density decreases 2-6% within 1-2 years of starting antiretroviral therapy (ART).
- The immediate or cumulative impact of ART on fracture rates remains unclear.
Purpose of the Study:
- To evaluate fracture incidence and predictors in HIV-positive individuals receiving ART.
- To determine the relationship between ART initiation and fracture risk over time.
Main Methods:
- Analysis of 4640 HIV-positive participants from 26 randomized ART studies in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial.
- Prospective recording of fragility and nonfragility fractures over a median of 5 years.
- Cox proportional hazards models to assess traditional fracture risks, HIV characteristics, and ART exposure.
Main Results:
- 116 fractures occurred in 106 participants over a median of 2.3 years.
- Fracture incidence was 0.40 per 100 person-years overall.
- ART-naive participants had higher fracture rates (0.53/100 person-years) within 2 years of ART initiation compared to later periods (0.30/100 person-years).
- Smoking and glucocorticoid use predicted higher fracture risk; specific antiretrovirals did not.
Conclusions:
- Fracture rates are elevated in the initial two years post-ART initiation.
- Sustained ART use was not linked to increased fracture rates in this cohort of relatively young HIV-positive individuals.
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