与HIV感染者骨折相关的因素：哪些因素至关重要？

Factors associated with fractures in HIV-infected persons: which factors matter?

作者信息

Gedmintas L, Wright E A, Dong Y, Lehmann E, Katz J N, Solomon D H, Losina E

机构信息

Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.

Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Osteoporos Int. 2017 Jan;28(1):239-244. doi: 10.1007/s00198-016-3704-6. Epub 2016 Jul 15.

DOI:10.1007/s00198-016-3704-6

PMID:27421978

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5480613/

Abstract

UNLABELLED

This study aims to determine what factors are associated with increased risk of fracture among patients with HIV, in particular whether an important medication used to treat HIV, tenofovir, is associated with fracture. Our study found that while co-infection with hepatitis C and markers of HIV severity were associated with fracture, tenofovir was not.

INTRODUCTION

Growing evidence suggests that tenofovir disoproxil fumarate decreases bone density among patients with HIV, but there are conflicting reports as to whether this decrease in bone density translates to higher fracture risk. We aimed to determine what factors were associated with an increased risk of fracture for patients with HIV, in particular whether tenofovir is associated with elevated fracture risk.

METHODS

We conducted a retrospective cohort study at two tertiary care hospitals in Boston, MA, between 2001 and 2012 to determine whether tenofovir use is associated with elevated all-site fracture risk, as compared to other antiretroviral medications. We also examined other potential factors associated with fracture among patients with HIV.

RESULTS

We identified 1981 HIV-infected patients who had at some point used tenofovir and 682 patients who had not. The mean age was 43 years, and 72 % were male. The hepatitis C co-infection rate was 28 %, about 40 % had nadir CD4 count <200, and about 40 % had a history of an AIDS-defining illness. We did not find an association between risk of fracture and tenofovir disoproxil fumarate (TDF) (adjusted RR (aRR) 0.8, 95 % CI 0.6-1.1). However, co-infection with hepatitis C did increase risk of fracture (aRR 1.6, 95 % CI 1.1-2.3), as did nadir CD4 count <200 (aRR 3.1, 95 % CI 1.9-5.0) and history of AIDS-defining illness (aRR 1.6, 95 % CI 1.1-2.2).

CONCLUSION

There was no association found between fracture and tenofovir use, but there were associations between co-infection with hepatitis C and markers of advanced HIV disease and fracture.

摘要

未标注

本研究旨在确定哪些因素与HIV患者骨折风险增加相关，尤其是用于治疗HIV的一种重要药物替诺福韦是否与骨折有关。我们的研究发现，虽然丙型肝炎合并感染和HIV严重程度标志物与骨折有关，但替诺福韦并非如此。

引言

越来越多的证据表明，富马酸替诺福韦二吡呋酯会降低HIV患者的骨密度，但关于这种骨密度降低是否会转化为更高的骨折风险，存在相互矛盾的报道。我们旨在确定哪些因素与HIV患者骨折风险增加相关，尤其是替诺福韦是否与骨折风险升高有关。

方法

2001年至2012年期间，我们在马萨诸塞州波士顿的两家三级护理医院进行了一项回顾性队列研究，以确定与其他抗逆转录病毒药物相比，使用替诺福韦是否与全部位骨折风险升高相关。我们还研究了HIV患者中与骨折相关的其他潜在因素。

结果

我们确定了1981名曾在某个时间使用过替诺福韦的HIV感染患者和682名未使用过替诺福韦的患者。平均年龄为43岁，72%为男性。丙型肝炎合并感染率为28%，约40%的患者最低点CD4细胞计数<200，约40%的患者有艾滋病定义疾病史。我们未发现骨折风险与富马酸替诺福韦二吡呋酯（TDF）之间存在关联（调整后风险比（aRR）0.8，95%置信区间0.6 - 1.1）。然而，丙型肝炎合并感染确实增加了骨折风险（aRR 1.6，95%置信区间1.1 - 2.3），最低点CD4细胞计数<200（aRR 3.1，95%置信区间1.9 - 5.0）以及艾滋病定义疾病史（aRR 1.6，95%置信区间1.1 - 2.2）也增加了骨折风险。