Negredo Eugènia, Bonjoch Anna, Puig Jordi, Echeverría Patricia, Estany Carla, Santos José R, Moltó José, Pérez-Álvarez Nuria, Ornelas Arelly, Clotet Bonaventura
Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain.
Statistics and Operations Research Department, Universitat Politècnica de Catalunya, Barcelona, Spain.
New Microbiol. 2015 Apr;38(2):193-9. Epub 2015 Apr 29.
Although some clinical trials have studied the impact of treatments on bone mineral density (BMD), scarce data are available about the impact of protease inhibitor (PI) monotherapies on BMD. The aim of this study was to evaluate changes in BMD in patients after one, two, or three years of a PI monotherapy. This study included 46 HIV-infected patients who switched from a conventional triple antiretroviral strategy to a monotherapy with lopinavir/ritonavir (LPV/r) or darunavir/ritonavir (DRV/r) for one (one-year group, n=16), two (two-year group, n=20), and three (three-year group, n=10) years. BMD was assessed by dual-energy X-ray absorptiometry (DXA). The median percentage of change in total femur BMD was 0.20% after one, 0.79% after two, and -0.31% after three years. The change in lumbar spine was -0.08%, -0.14%, and 0.50% % after the same years. No significant differences were found when patients were classified regarding the type of PI and whether or not had previously received PI or tenofovir. However, patients who interrupted tenofovir or those who started with DRV/r had a higher BMD increment. Patients who had taken non-nucleoside reverse transcriptase inhibitors previously decreased BMD when started PIs. Monotherapy treatment with ritonavir-boosted protease inhibitors (both LPV/r and DRV/r) during one, two, or three years leads to the stabilization of BMD in HIV-infected patients with long-term virological suppression. Larger studies are necessary to compare the effect of starting or withdrawing PIs on BMD.
尽管一些临床试验研究了治疗对骨矿物质密度（BMD）的影响，但关于蛋白酶抑制剂（PI）单一疗法对BMD影响的数据却很少。本研究的目的是评估PI单一疗法治疗1年、2年或3年后患者BMD的变化。本研究纳入了46例HIV感染患者，他们从传统的三联抗逆转录病毒策略转换为使用洛匹那韦/利托那韦（LPV/r）或达芦那韦/利托那韦（DRV/r）进行单一疗法治疗1年（1年组，n = 16）、2年（2年组，n = 20）和3年（3年组，n = 10）。通过双能X线吸收法（DXA）评估BMD。股骨总BMD的中位变化百分比在1年后为0.20%，2年后为0.79%，3年后为 -0.31%。同期腰椎的变化分别为 -0.08%、-0.14%和0.50%。根据PI类型以及患者之前是否接受过PI或替诺福韦进行分类时，未发现显著差异。然而，中断替诺福韦治疗的患者或开始使用DRV/r治疗的患者BMD增加幅度更大。之前服用过非核苷类逆转录酶抑制剂的患者在开始使用PI时BMD会下降。在1年、2年或3年内使用利托那韦增强的蛋白酶抑制剂（LPV/r和DRV/r）进行单一疗法治疗可使长期病毒学抑制的HIV感染患者的BMD保持稳定。需要开展更大规模的研究来比较开始或停用PI对BMD的影响。
