Fractures after antiretroviral initiation.

TitleFractures after antiretroviral initiation.
Publication TypeJournal Article
Year of Publication2012
AuthorsYin MT, Kendall MA, Wu X, Tassiopoulos K, Hochberg M, Huang JS, Glesby MJ, Bolivar H, McComsey GA
Date Published2012 Nov 13
KeywordsAccidental Falls, Acquired Immunodeficiency Syndrome, Adult, Anti-HIV Agents, Body Mass Index, Bone Density, CD4 Lymphocyte Count, Female, Follow-Up Studies, Fractures, Bone, Glucocorticoids, HIV Seropositivity, Humans, Incidence, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Smoking, Surveys and Questionnaires, Time Factors

BACKGROUND: Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates.

METHODS: We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence.

RESULTS: Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals.

CONCLUSION: Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.

Alternate JournalAIDS
PubMed ID22951635
PubMed Central IDPMC3652631
Grant ListAI06534 / AI / NIAID NIH HHS / United States
AI095089 / AI / NIAID NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
AI69501 / AI / NIAID NIH HHS / United States
K24AI078884 / AI / NIAID NIH HHS / United States
R01 AI095089 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States