Low baseline CD4+ count is associated with greater bone mineral density loss after antiretroviral therapy initiation.

TitleLow baseline CD4+ count is associated with greater bone mineral density loss after antiretroviral therapy initiation.
Publication TypeJournal Article
Year of Publication2013
AuthorsGrant PM, Kitch D, McComsey GA, Dubé MP, Haubrich R, Huang J, Riddler S, Tebas P, Zolopa AR, Collier AC, Brown TT
JournalClin Infect Dis
Volume57
Issue10
Pagination1483-8
Date Published2013 Nov
ISSN1537-6591
KeywordsAbsorptiometry, Photon, Adult, Analysis of Variance, Anti-HIV Agents, Bone Density, CD4 Lymphocyte Count, Female, HIV Infections, Humans, Linear Models, Male, Middle Aged, Risk Factors, Viral Load
Abstract

BACKGROUND: Bone mineral density (BMD) decreases 2%-6% in the 2 years after antiretroviral therapy (ART) initiation. Pre-ART immune deficiency and early immune recovery may contribute to this loss.

METHODS: We pooled data from 3 studies of ART initiation in treatment-naive patients in which serial whole-body dual-energy X-ray absorptiometry scans were performed. We used linear regression to evaluate effects of baseline CD4(+) and 16-week CD4(+) change (both absolute and relative) on 96-week total BMD change from baseline. We performed multivariable linear regression to assess associations between baseline variables of age, sex, race/ethnicity, body mass index (BMI), hepatitis C status, parent study, human immunodeficiency virus type 1 (HIV-1) RNA level, and assignment to a protease inhibitor (PI)- or tenofovir-containing regimen on 96-week total BMD change.

RESULTS: The included 796 subjects had mean 96-week total BMD loss of 2.0%. In multivariable analysis, baseline CD4(+) cell count was significantly associated with 96-week BMD loss; individuals with baseline CD4(+) <50 cells/µL lost significantly more BMD compared to those with CD4(+) ≥500 cells/µL. A greater relative, but not absolute, 16-week increase in CD4(+) count was significantly associated with greater declines in BMD, but not after controlling for baseline CD4(+) count. In multivariable analysis, older age, female sex, lower BMI, higher HIV-1 RNA levels, and PI and tenofovir assignment were also associated with greater BMD decline.

CONCLUSIONS: Low pretreatment CD4(+) count, but not greater CD4(+) count increase, is a strong and independent risk factor for bone loss after ART initiation. ART initiation at higher CD4(+) counts may reduce the burden of osteoporosis and fragility fractures.

DOI10.1093/cid/cit538
Alternate JournalClin. Infect. Dis.
PubMed ID23943825
PubMed Central IDPMC3805172
Grant ListAI064086 / AI / NIAID NIH HHS / United States
AI065348 / AI / NIAID NIH HHS / United States
AI068634 / AI / NIAID NIH HHS / United States
AI069432 / AI / NIAID NIH HHS / United States
AI36214 / AI / NIAID NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
K24 AI064086 / AI / NIAID NIH HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069432 / AI / NIAID NIH HHS / United States
UM1 AI069494 / AI / NIAID NIH HHS / United States
UM1 AI069534 / AI / NIAID NIH HHS / United States
UM1AI069434 / AI / NIAID NIH HHS / United States