不同抗逆转录病毒治疗方案对HIV感染者骨矿物质密度的影响：一项中国的回顾性纵向研究

Impact of different antiretroviral therapy regimens on bone mineral density in people living with HIV: a retrospective and longitudinal study in China.

作者信息

Liang Xuelei, Zhang Hanxi, Guo Mingnan, Zhao Hongxin, Yang Di, Sun Rui, Lao Xiaojie, Xu Yali, Yu Fengting, Zhang Fujie

机构信息

Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun E St, Chaoyang District, Beijing, 100015, China.

Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China.

出版信息

BMC Infect Dis. 2024 Dec 18;24(1):1400. doi: 10.1186/s12879-024-10299-y.

DOI:10.1186/s12879-024-10299-y

PMID:39695982

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11654311/

Abstract

BACKGROUND

HIV infection and antiretroviral therapy (ART) are associated with bone loss of people living with HIV (PLWH), but limited studies exist on the impacts of ART regimens on bone mineral density (BMD) in China. This study evaluated BMD changes with three common ART regimens: tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + efavirenz (EFV), tenofovir alafenamide (TAF)-containing, and dolutegravir (DTG)-containing (non-TDF/non-TAF) therapies.

METHODS

In this retrospective study, the prevalence of low BMD was analyzed in PLWH who underwent dual-energy X-ray absorptiometry (DXA) before ART initiation. BMD changes were assessed in participants who had follow-up DXA scans after ≥ 1 year of ART with TDF + 3TC + EFV, TAF-containing, or DTG-containing regimens. We used multivariate logistic regression to evaluate the impact of different ART regimens on > 3% BMD reduction, adjusting for demographic and clinical variables that were significant in univariate analysis (P < 0.10).

RESULTS

22.99% (630/2740) of PLWH before ART initiation had low BMD. Among 571 individuals followed up for over 1 year, BMD at the femoral neck (FN) and total hip (TH) decreased significantly in the TDF + 3TC + EFV [FN: -0.03(-0.07, 0.00) g/cm, TH: -0.02(-0.05, 0.00) g/cm, P < 0.001 for both] and TAF-containing regimens [FN: -0.02(-0.05, 0.01) g/cm, TH: -0.02(-0.04, 0.01) g/cm, P < 0.001 for both]. Lumbar spine (LS) BMD decreased significantly only with TDF + 3TC + EFV [-0.02(-0.05, 0.01) g/cm, P < 0.001]. TDF + 3TC + EFV caused greater BMD loss at the FN and LS than the TAF-containing regimen[FN: -3.66% (-8.05%, 0.34%) vs. -2.38% (-5.44%, 1.12%), P = 0.044; LS: -2.11% (-4.50%, 0.62%) vs.-0.06% (-2.05%, 2.57%), P < 0.001]. Compared to TDF + 3TC + EFV, DTG-containing regimens showed smaller BMD reductions across all sites [FN: -1.49% (-4.65%, 3.83%), TH: 0.00% (-3.98%, 3.18%), LS: 0.59% (-2.73%, 3.09%), P = 0.004, 0.008 and 0.004, respectively]. TAF-containing and DTG-containing regimens showed no significant differences in BMD changes. Multivariable logistic regression showed that TDF + 3TC + EFV, compared to DTG-containing regimens, had higher odds of > 3% FN and LS BMD reduction (FN: OR 2.91, 95% CI: 1.33 to 6.37, P = 0.009; LS: OR 2.93, 95% CI: 1.17 to 7.32, P = 0.022), while TAF-containing regimens were not independently linked to > 3% BMD loss (P > 0.05).

CONCLUSIONS

TAF-containing and DTG-containing regimens caused less bone loss than TDF + 3TC + EFV, offering safer options for preserving bone health in Chinese PLWH.

摘要

背景

HIV感染及抗逆转录病毒疗法（ART）与HIV感染者（PLWH）的骨质流失有关，但在中国，关于ART方案对骨密度（BMD）影响的研究有限。本研究评估了三种常见ART方案（替诺福韦酯（TDF）+拉米夫定（3TC）+依非韦伦（EFV）、含替诺福韦艾拉酚胺（TAF）以及含多替拉韦（DTG）（非TDF/非TAF）疗法）对BMD的影响。

方法

在这项回顾性研究中，分析了ART起始前接受双能X线吸收法（DXA）检查的PLWH中低BMD的患病率。对接受TDF+3TC+EFV、含TAF或含DTG方案进行≥1年ART治疗后接受DXA随访扫描的参与者评估BMD变化。我们使用多因素逻辑回归评估不同ART方案对BMD降低>3%的影响，并对单因素分析中有意义（P<0.10）的人口统计学和临床变量进行校正。

结果

ART起始前22.99%（630/2740）的PLWH存在低BMD。在571名随访超过1年的个体中，TDF+3TC+EFV组[股骨颈（FN）：-0.03（-0.07，0.00）g/cm，全髋（TH）：-0.02（-0.05，0.00）g/cm，两者P<0.001]和含TAF方案组[FN：-0.02（-0.05，0.01）g/cm，TH：-0.02（-0.04，0.01）g/cm，两者P<0.001]的FN和TH处BMD显著降低。仅TDF+3TC+EFV组腰椎（LS）BMD显著降低[-0.02（-0.05，0.01）g/cm，P<0.001]。TDF+3TC+EFV组在FN和LS处的BMD损失大于含TAF方案组[FN：-3.66%（-8.05%，0.34%）对-2.38%（-5.44%，1.12%），P=0.044；LS：-2.11%（-4.50%，0.62%）对-0.06%（-2.05%，2.57%），P<0.001]。与TDF+3TC+EFV组相比，含DTG方案组在所有部位的BMD降低幅度较小[FN：-1.49%（-4.65%，3.83%），TH：0.00%（-3.98%，3.18%），LS：0.59%（-2.7%，3.09%），P分别为0.004、0.008和0.004]。含TAF和含DTG方案组在BMD变化方面无显著差异。多因素逻辑回归显示，与含DTG方案组相比，TDF+3TC+EFV组FN和LS处BMD降低>3%的几率更高（FN：OR 2.91，95%CI：1.33至6.37，P=0.009；LS：OR 2.93，95%CI：1.至7.32，P=0.022），而含TAF方案组与BMD损失>3%无独立关联（P>0.05）。