| |
Accelerated Bone Mineral Loss in HIV-Infected Patients Receiving Potent Antiretroviral Therapy P. TEBAS*, W. G. POWDERLY, S. CLAXTON, D. MARIN, W. TANTISIRIWAT, S. L.TEITELBAUM, and K. E.YARASHESKI.
Washington Univ. Sch. of Med., St.Louis, MO Background: The use of potent antiretroviral therapy (HAART) has been associated with multiple metabolic complications whose pathogenesis is poorly understood at the present time. There have been anecdotal reports of bone disorders like avascular necrosis of the hip and compression fractures of the lumbar spine in HIV-infected patients receiving HAART
Methods: We analyzed whole-body, lumbar spine (L1-L4) and proximal femur bone mineral density (BMD) in 122 HIV-infected patients on HAART that included a protease inhibitor (n=64), HIV-infected patients not receiving a protease inhibitor (n=36) and healthy seronegative adults (n=22) using dual energy x-ray absorptiometry.
Findings: Men receiving protease inhibitors had higher incidence of osteopenia and/or osteoporosis according to World Health Organization definitions: RR=2.19 (95% confidence interval 1.13-4.23) (p=0.02). 21 percent of patients receiving protease inhibitor containing regimens had severe osteoporosis (z- scores less than 2 SD below normal for age, sex and race) compared with 6% among controls. Subjects receiving protease inhibitors had greater central to appendicular adipose tissue ratios than the other 2 groups (p<0.0001). However, there was no relationship between the central to appendicular fat ratio and the lumbar spine or proximal femur BMD, suggesting that osteoporosis and body fat redistribution are independent side effects of HAART.
Interpretation: Osteopenia and osteoporosis are unique metabolic complications associated with protease inhibitor containing potent antiretroviral regimens, that appear to be independent of adipose tissue maldistribution.
Key Words: fat redistribution, osteoporosis, protease inhibitors
|
