Improvement of BMD after Switching from Lopinavir/R Plus Two Nucleos(T)ide Reverse Transcriptase Inhibitors to...

Area of Science:

• HIV/AIDS research
• Pharmacology
• Bone metabolism

Background:

• Antiretroviral therapy (ART) can impact bone mineral density (BMD) and body fat distribution.
• Lopinavir/ritonavir combined with nucleoside reverse transcriptase inhibitors (NRTIs) is a common ART regimen.
• Optimizing ART regimens to mitigate long-term side effects is crucial for HIV management.

Purpose of the Study:

• To compare 48-week changes in BMD and body fat distribution.
• To evaluate outcomes in HIV patients continuing lopinavir/ritonavir plus two NRTIs versus switching to lopinavir/ritonavir plus lamivudine.

Main Methods:

• A randomized, open-label, multicenter substudy of an OLE study.
• Adult HIV-infected patients with viral suppression (<50 copies/mL for ≥6 months) were randomized.
• Dual-energy X-ray absorptiometry (DXA) assessed BMD and body fat at baseline and 48 weeks.

Main Results:

• Total BMD increased by 1.04% in the dual-therapy group (switching to lopinavir/ritonavir and lamivudine), with no significant change in the triple-therapy group.
• Discontinuing tenofovir-DF was associated with significant increases in total BMD and total hip BMD.
• No significant changes in body fat distribution were observed in either treatment group.

Conclusions:

• Switching to lopinavir/ritonavir plus lamivudine improved BMD in HIV patients on suppressive triple therapy.
• The findings suggest potential benefits of simplifying ART regimens for bone health.
• Further research may explore long-term effects and optimal ART strategies for bone health in HIV.