优化艾滋病毒感染者的骨健康:随机对照试验网络元分析的见解
Jui-Chien Wang1,2, Sun-Mei Chung2,3, Po-Ting Wu4,5,6
1Taipei Veterans General Hospital, Taipei, Taiwan.
EClinicalMedicine
|March 5, 2025
概括
佐莱德酸盐显著改善了艾滋病毒感染者 (PLWH) 的骨密度,特别是那些接受抗逆转录病毒疗法 (ART) 的人. 然而,它在以前没有使用过ART的个体中的有效性需要进一步研究.
科学领域:
- 在艾滋病毒感染的背景下,骨健康和骨质疏松症管理.
- 在免疫受损人群中治疗骨质疏松症的药理干预措施.
背景情况:
- 艾滋病毒感染者 (PLWH) 面临由于艾滋病毒感染和抗逆转录病毒疗法 (ART),特别是tenofovir disoproxil fumarate (TDF),骨质疏松症的风险增加.
- 在PLWH中管理早期开始的骨质疏松症的最佳策略尚未确立,尽管双酸盐的常见使用.
研究的目的:
- 通过网络元分析,比较不同抗骨质疏松症药物 (AOM) 在感染艾滋病毒 (PLWH) 的人群中的疗效.
- 评估甲酸,甲酸和/维生素D对PLWH骨矿物质密度 (BMD) 和骨周转指标 (BTMs) 的影响.
主要方法:
- 进行了11项随机对照试验 (RCT) 的网络元分析 (NMA),涉及816名参与者.
- 主要结局包括腰椎变化 (LS-BMD) 和骨总矿物密度 (TH-BMD).
- 二次结果评估了骨循环标记 (CTx,OC) 和与AOMs相关的不良事件.
主要成果:
- 在混合PLWH群体中,基于佐莱德酸的疗法显著改善了LS-BMD和TH-BMD,在BMD改善方面排名最高.
- 基于阿伦德罗纳特的疗法显著降低了CTx,但没有显著改善BMD.
- 在ART经验丰富的PLWH中,和维生素D的佐莱德酸盐显示了LS-BMD和TH-BMD的最高排名;然而,在ART-naïve患者中,没有治疗比较优越.
结论:
- 基于zoledronate的治疗方法在混合和ART经验丰富的PLWH群体中显示出最显著的骨矿物质密度改善.
- 对于先前没有服用ART的PLWH患者的佐莱德酸的有效性仍然不确定,需要进一步的研究.
- 由于证据有限和异质性,额外的试验至关重要,以确定最终的治疗策略,特别是对于先前没有使用ART的个体.
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