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

57 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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