Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, and.
Institute for Clinical Medicine, University of Copenhagen, Denmark.
Clin Infect Dis. 2017 May 15;64(10):1413-1421. doi: 10.1093/cid/cix167.
Antiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes.
EuroSIDA participants were followed to assess fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed.
During 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70.4% virologically suppressed), there were 619 fractures (incidence/1000 PYFU 7.2; 95% CI 6.6-7.7) and 89 osteonecrosis (1.0; 0.8-1.3). Older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV coinfection, prior osteonecrosis, prior fracture, cardiovascular disease, and recent non-AIDS cancer (last 12 months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y exposure; 0.94-1.25). No other ARV was associated with fractures (all P > .1). Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture, and prior AIDS. After mutual adjustment, no ARV was associated with osteonecrosis.
In human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures.
抗逆转录病毒药物（ARV）会影响骨密度和代谢，但它们对骨折和股骨头坏死风险的影响知之甚少。我们研究了接触 ARV 是否会增加这两种骨骼结果的风险。
EuroSIDA 参与者接受了骨折和骨坏死评估。泊松回归确定了这两种骨骼结果的临床、实验室和人口统计学预测因素。评估了 ARV 的既往、当前和累积暴露情况。
在纳入的 11820 人中（中位年龄 41 岁，75%为男性，中位基线 CD4 计数为 440/mm3，70.4%病毒学抑制），共发生了 619 例骨折（发生率/1000 人年为 7.2；95%CI 6.6-7.7）和 89 例骨坏死（1.0；0.8-1.3）。年龄较大、白种人、较低的 BMI、静脉吸毒、较低的基线 CD4、HCV 合并感染、既往骨坏死、既往骨折、心血管疾病和最近非艾滋病癌症（过去 12 个月）与骨折有关。调整后，曾使用替诺福韦二吡呋酯（TDF）（1.40；1.15-1.70）或当前正在使用 TDF（1.25；1.05-1.49）的人骨折发生率更高。累积 TDF 暴露与骨折无关（5 年暴露 1.08；0.94-1.25）。其他 ARV 与骨折均无关（均 P>.1）。骨坏死的风险与白种人、最低 CD4 计数、既往骨坏死、既往骨折和既往艾滋病有关。在相互调整后，没有 ARV 与骨坏死有关。
在人类免疫缺陷病毒（HIV）感染中，宿主因素、HIV 特异性变量和合并症会增加骨折和骨坏死的风险。接触 TDF（而非其他 ARV）是骨折的独立危险因素。
