Hsieh E, Fraenkel L, Xia W, Hu Y Y, Han Y, Insogna K, Yin M T, Xie J, Zhu T, Li T
Department of Infectious Diseases, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
Osteoporos Int. 2015 Mar;26(3):1035-44. doi: 10.1007/s00198-014-2874-3. Epub 2014 Sep 16.
We sought to evaluate the effects of antiretroviral therapy on skeletal metabolism in Chinese individuals with human immunodeficiency virus. Patients switched to tenofovir/lamivudine + lopinavir/ritonavir after treatment failure had an increase in bone resorption marker levels by nearly 60%, which is greater than the magnitude previously described in non-Chinese populations.
Few studies have evaluated the effects of antiretroviral therapy on skeletal metabolism in Asian populations infected with human immunodeficiency virus (HIV).
We performed a secondary analysis of bone turnover markers (BTM) at baseline and 2 years in stored plasma samples collected from 2/2009 to 1/2013 as part of a multi-center trial. Two groups were compared: (1) treatment-naïve patients initiated on zidovudine (AZT)/lamivudine (3TC) plus nevirapine (NVP) and (2) patients who failed first-line therapy and were switched to tenofovir (TDF)/3TC plus lopinavir/ritonavir (LPVr). Tests included the bone resorption marker, C-terminal cross-linking telopeptide of type-1 collagen (CTX), and the bone formation marker procollagen type 1 N-terminal propeptide (P1NP).
In the TDF/3TC + LPVr group, samples were available from 59 patients at baseline and 56 patients at 2 years. Of these, 36 patients had samples available from both time points. In the AZT/3TC + NVP group, plasma samples were analyzed from 82 participants at baseline and of those, 61 had samples at 2 years. Median change over 2 years was greater in the TDF/3TC + LPVr group for both CTX (+0.24 ng/mL, interquartile ranges (IQR) 0.10-0.43 vs. +0.09 ng/mL, IQR -0.03 to 0.18, p = 0.001) and P1NP (+25.5 ng/mL, IQR 2.4-51.3 vs. +7.11 ng/mL, IQR -4.3 to 21.6, p = 0.012). Differences remained after adjusting for potential confounders in the multivariable analysis.
Switching to TDF/3TC + LPVr after treatment failure resulted in greater increases in BTMs than initiation with AZT/3TC + NVP in Chinese patients with HIV. Following this change, bone resorption marker levels increased by nearly 60 %, which is greater than the 25-35% increase from baseline described previously in non-Chinese populations. Further studies are warranted to elucidate these findings.
我们试图评估抗逆转录病毒疗法对中国人类免疫缺陷病毒感染者骨骼代谢的影响。治疗失败后改用替诺福韦/拉米夫定+洛匹那韦/利托那韦的患者，其骨吸收标志物水平增加了近60%，这一增幅大于先前在非中国人群中描述的幅度。
很少有研究评估抗逆转录病毒疗法对感染人类免疫缺陷病毒（HIV）的亚洲人群骨骼代谢的影响。
作为一项多中心试验的一部分，我们对2009年2月至2013年1月收集的储存血浆样本中的骨转换标志物（BTM）进行了基线和2年时的二次分析。比较了两组：（1）初治患者开始使用齐多夫定（AZT）/拉米夫定（3TC）加奈韦拉平（NVP），以及（2）一线治疗失败并改用替诺福韦（TDF）/3TC加洛匹那韦/利托那韦（LPVr）的患者。检测包括骨吸收标志物1型胶原C末端交联肽（CTX）和骨形成标志物1型前胶原N末端前肽（P1NP）。
在TDF/3TC+LPVr组中，基线时有59例患者有样本，2年时有56例患者有样本。其中36例患者在两个时间点都有样本。在AZT/3TC+NVP组中，对82名参与者的血浆样本进行了基线分析，其中61名在2年时有样本。TDF/3TC+LPVr组2年期间的中位数变化在CTX（+0.24 ng/mL，四分位间距（IQR）0.10 - 0.43 vs. +0.09 ng/mL，IQR -0.03至0.18，p = 0.001）和P1NP（+25.5 ng/mL，IQR 2.4 - 51.3 vs. +7.11 ng/mL，IQR -4.3至21.6，p = 0.012）方面均更大。在多变量分析中调整潜在混杂因素后差异仍然存在。
在中国HIV患者中，治疗失败后改用TDF/3TC+LPVr导致BTM的增加幅度大于开始使用AZT/3TC+NVP。这一变化后，骨吸收标志物水平增加了近60%，大于先前在非中国人群中描述的从基线增加25 - 35%的幅度。有必要进行进一步研究以阐明这些发现。
