Fractures after antiretroviral initiation

Michael T. Yin, Michelle A. Kendall, Xingye Wu, Katherine Tassiopoulos, Marc Hochberg, Jeannie S. Huang, Marshall J. Glesby, Hector Bolivar, Grace A. McComsey

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates. METHODS: We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence. RESULTS: Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals. CONCLUSION: Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.

Original languageEnglish (US)
Pages (from-to)2175-2184
Number of pages10
JournalAIDS
Volume26
Issue number17
DOIs
StatePublished - Nov 13 2012

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Incidence
HIV
Therapeutics
Acquired Immunodeficiency Syndrome
Clinical Trials
Implosive Therapy
CD4 Lymphocyte Count
Proportional Hazards Models
Bone Density
Glucocorticoids
Multivariate Analysis
Smoking

Keywords

  • antiretroviral initiation
  • bone loss
  • fracture
  • fracture incidence
  • HIV

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Yin, M. T., Kendall, M. A., Wu, X., Tassiopoulos, K., Hochberg, M., Huang, J. S., ... McComsey, G. A. (2012). Fractures after antiretroviral initiation. AIDS, 26(17), 2175-2184. https://doi.org/10.1097/QAD.0b013e328359a8ca

Fractures after antiretroviral initiation. / Yin, Michael T.; Kendall, Michelle A.; Wu, Xingye; Tassiopoulos, Katherine; Hochberg, Marc; Huang, Jeannie S.; Glesby, Marshall J.; Bolivar, Hector; McComsey, Grace A.

In: AIDS, Vol. 26, No. 17, 13.11.2012, p. 2175-2184.

Research output: Contribution to journalArticle

Yin, MT, Kendall, MA, Wu, X, Tassiopoulos, K, Hochberg, M, Huang, JS, Glesby, MJ, Bolivar, H & McComsey, GA 2012, 'Fractures after antiretroviral initiation', AIDS, vol. 26, no. 17, pp. 2175-2184. https://doi.org/10.1097/QAD.0b013e328359a8ca
Yin MT, Kendall MA, Wu X, Tassiopoulos K, Hochberg M, Huang JS et al. Fractures after antiretroviral initiation. AIDS. 2012 Nov 13;26(17):2175-2184. https://doi.org/10.1097/QAD.0b013e328359a8ca
Yin, Michael T. ; Kendall, Michelle A. ; Wu, Xingye ; Tassiopoulos, Katherine ; Hochberg, Marc ; Huang, Jeannie S. ; Glesby, Marshall J. ; Bolivar, Hector ; McComsey, Grace A. / Fractures after antiretroviral initiation. In: AIDS. 2012 ; Vol. 26, No. 17. pp. 2175-2184.
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AB - BACKGROUND: Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates. METHODS: We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence. RESULTS: Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals. CONCLUSION: Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.

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