[Impact of long-term highly active antiretroviral therapy on bone metabolism in AIDS patients]

To evaluate the influence of long-term highly active antiretroviral therapy (HAART) on bone metabolism in patients with acquired immune deficiency syndrome (AIDS).

A total of 82 AIDS patients who received HAART in the First Affiliated Hospital of Zhejiang University Medical School during January 2012 and May 2016 were enrolled in the study. Patients were divided into TDF group (n=41) and AZT group (n=41), and glomerular filtration rate (GFR), serum calcium, serum phosphate and serum ALP levels in 6, 12, 18, 24 and 30-month during the treatment were analyzed in both groups.

Both TDF-based and AZT-based therapies significantly improved CD4(+) T-cell levels of the patients, and no significant difference was observed between the groups. Compared with the baseline, GFR [(120.71±62.85) vs(110.08±39.18) mL/min] and serum phosphate [(1.25±0.19) vs(1.22±0.21) mmol/L] levels rose after 6-month treatment in TDF group, but the difference was not statistically significant (P>0.05); Serum ALP [99.0(79.5-124.0) U/L vs 80.0(60.5-96.0) U/L] and serum calcium [(2.32±0.12) vs(2.25±0.17) mmol/L] levels rose significantly (P<0.05). As treatment continued, the levels of GFR, serum calcium and serum phosphate declined, while the serum ALP number was still increasing. After 30 months of HAART, the level of serum calcium [(2.16±0.15) vs(2.25±0.17) mmol/L], serum phosphate [(1.06±0.17) vs(1.22±0.21) mmol/L], GFR [(98.13±30.43) vs (110.08±39.18) mL/min] declined significantly (P<0.05) in TDF group, while serum ALP [110.0(98.5-120.5) U/L vs 80.0(60.5-96.0) U/L, P<0.05] increased. In AZT group, serum calcium and serum ALP levels rose and GFR level was declined (P<0.05), while serum phosphate level was not significantly changed during the treatment (P>0.05). Compared with AZT group, there were greater changes on the levels of GFR, serum calcium, serum phosphate and serum ALP in TDF group.

HAART is effective for patients with AIDS, and TDF-based therapy may have significant impact on bone metabolism of the patients, which needs close monitoring and timely intervention or adjustment if necessary.