Abdo Mona, Coyle Ryan P, Seifert Sharon M, Castillo-Mancilla Jose R, Jankowski Catherine M, Mawhinney Samantha, Anderson Peter L, Erlandson Kristine M
Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA.
Division of Infectious Diseases, School of Medicine, University of Colorado-Anshutz Medical Campus, Aurora, Colorado, USA.
Open Forum Infect Dis. 2020 Nov 27;8(1):ofaa577. doi: 10.1093/ofid/ofaa577. eCollection 2021 Jan.
In this study, we evaluate associations between cumulative antiretroviral adherence/exposure, quantified using tenofovir diphosphate (TFV-DP) in dried blood spots (DBS), and human immunodeficiency virus (HIV)-related aging factors.
This is a cross-sectional analysis of younger (ages 18-35) and older (ages ≥60) persons with HIV (PWH) taking TFV disoproxil fumarate. Tenofovir diphosphate concentrations were quantified in DBS. Linear and logistic regression models were used to evaluate associations between TFV-DP and bone mineral density (BMD), physical function, frailty, and falls.
Forty-five PWH were enrolled (23 younger, 22 older). Every 500 fmol/punch (equivalent to an increase in ~2 doses/week) increase in TFV-DP was associated with decreased hip BMD (-0.021 g/cm; 95% confidence interval [CI], -0.040 to -0.002; = .03). Adjusting for total fat mass, every 500 fmol/punch increase in TFV-DP was associated with higher odds of Short Physical Performance Battery impairment (score ≤10; adjusted odds ratio [OR], 1.6; 95% CI, 1.0-2.5; = .04). Every 500 fmol/punch increase in TFV-DP was associated with slower 400-meter walk time (14.8 seconds; 95% CI, 3.8-25.8; = .01) and remained significant after adjusting for age, lean body mass, body mass index (BMI), and fat mass (all ≤ .01). Every 500 fmol/punch increase in TFV-DP was associated with higher odds of reporting a fall in the prior 6 months (OR, 1.8; 95% CI, 1.1-2.8; = .02); this remained significant after adjusting for age, lean body mass, BMI, and total fat mass (all < .05).
Higher TFV-DP levels were associated with lower hip BMD, poorer physical function, and greater risk for falls, a concerning combination for increased fracture risk.
在本研究中，我们评估了使用干血斑（DBS）中的替诺福韦二磷酸（TFV-DP）定量的累积抗逆转录病毒药物依从性/暴露与人类免疫缺陷病毒（HIV）相关衰老因素之间的关联。
这是一项对服用富马酸替诺福韦二吡呋酯的年轻（18 - 35岁）和年长（≥60岁）HIV感染者（PWH）的横断面分析。对DBS中的替诺福韦二磷酸浓度进行定量。使用线性和逻辑回归模型评估TFV-DP与骨矿物质密度（BMD）、身体功能、虚弱和跌倒之间的关联。
共纳入45名PWH（23名年轻者，22名年长者）。TFV-DP每增加500 fmol/打孔（相当于每周增加约2剂）与髋部BMD降低相关（-0.021 g/cm；95%置信区间[CI]，-0.040至-0.002；P = 0.03）。调整总脂肪量后，TFV-DP每增加500 fmol/打孔与短身体性能电池受损几率更高相关（得分≤10；调整后的优势比[OR]，1.6；95% CI，1.0 - 2.5；P = 0.04）。TFV-DP每增加500 fmol/打孔与400米步行时间延长相关（14.8秒；95% CI，3.8 - 25.8；P = 0.01），在调整年龄、瘦体重、体重指数（BMI）和脂肪量后仍具有显著性（所有P≤0.01）。TFV-DP每增加500 fmol/打孔与在过去6个月内报告跌倒的几率更高相关（OR，1.8；95% CI，1.1 - 2.8；P = 0.02）；在调整年龄、瘦体重、BMI和总脂肪量后仍具有显著性（所有P<0.05）。
较高的TFV-DP水平与较低的髋部BMD、较差的身体功能以及更高的跌倒风险相关，这是增加骨折风险的一个令人担忧的组合。
