Title | Weight and lean body mass change with antiretroviral initiation and impact on bone mineral density. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Erlandson KM, Kitch D, Tierney C, Sax PE, Daar ES, Tebas P, Melbourne K, Ha B, Jahed NC, McComsey GA |
Journal | AIDS |
Volume | 27 |
Issue | 13 |
Pagination | 2069-79 |
Date Published | 2013 Aug 24 |
ISSN | 1473-5571 |
Keywords | Absorptiometry, Photon, Adult, Anti-Retroviral Agents, Body Composition, Body Weight, Bone Density, Female, HIV Infections, HIV-1, Humans, Male, Middle Aged, Prospective Studies, Radiography, Abdominal, Tomography, X-Ray Computed |
Abstract | OBJECTIVE: To compare the effect that initiating different antiretroviral therapy (ART) regimens has on weight, BMI, and lean body mass (LBM) and explore how changes in body composition are associated with bone mineral density (BMD). METHODS: A5224s was a sub-study of A5202, a prospective trial of 1857 ART-naive participants randomized to blinded abacavir-lamivudine (ABC/3TC) or tenofovir DF-emtricitabine (TDF/FTC) with open-label efavirenz (EFV) or atazanavir-ritonavir (ATV/r). All participants underwent dual-energy absorptiometry (DXA) and abdominal computed tomography for body composition. Analyses used two-sample t-tests and linear regression. RESULTS: A5224s included 269 participants: 85% men, 47% white non-Hispanic, median age 38 years, HIV-1 RNA 4.6 log10 copies/ml, and CD4 cell count 233 cells/μl. Overall, significant gains occurred in weight, BMI, and LBM at 96 weeks post-randomization (all P<0.001). Assignment to ATV/r (vs. EFV) resulted in significantly greater weight (mean difference 3.35 kg) and BMI gain (0.88 kg/m; both P=0.02), but not LBM (0.67 kg; P=0.15), whereas ABC/3TC and TDF/FTC were not significantly different (P≥0.10). In multivariable analysis, only lower baseline CD4 cell count and higher HIV-1 RNA were associated with greater increase in weight, BMI, or LBM. In multivariable analyses, increased LBM was associated with an increased hip BMD. CONCLUSION: ABC/3TC vs. TDF/FTC did not differ in change in weight, BMI, or LBM; ATV/r vs. EFV resulted in greater weight and BMI gain but not LBM. A positive association between increased LBM and increased hip BMD should be further investigated through prospective interventional studies to verify the impact of increased LBM on hip BMD. |
DOI | 10.1097/QAD.0b013e328361d25d |
Alternate Journal | AIDS |
PubMed ID | 24384588 |
PubMed Central ID | PMC3966569 |
Grant List | 1 U01 AI069494-01 / AI / NIAID NIH HHS / United States 1U01AI069424-01 / AI / NIAID NIH HHS / United States 3U01AI046376-05S4 / AI / NIAID NIH HHS / United States 5 U0I AI069415-03 / AI / NIAID NIH HHS / United States 5-U01 AI069423-03 / AI / NIAID NIH HHS / United States 5U01 AI069484-02 / AI / NIAID NIH HHS / United States 5U01AI025859 / AI / NIAID NIH HHS / United States 5U01AI069494 / AI / NIAID NIH HHS / United States AI 27661 / AI / NIAID NIH HHS / United States AI068634 / AI / NIAID NIH HHS / United States AI0694241 / AI / NIAID NIH HHS / United States AI069434 / AI / NIAID NIH HHS / United States AI069474 / AI / NIAID NIH HHS / United States AI069513 / AI / NIAID NIH HHS / United States AI069532 / AI / NIAID NIH HHS / United States AI27658 / AI / NIAID NIH HHS / United States AI27665 / AI / NIAID NIH HHS / United States AI27668 / AI / NIAID NIH HHS / United States AI32782 / AI / NIAID NIH HHS / United States AI34853 / AI / NIAID NIH HHS / United States AI38855 / AI / NIAID NIH HHS / United States AI46339-01 / AI / NIAID NIH HHS / United States AI69432 / AI / NIAID NIH HHS / United States AI69450 / AI / NIAID NIH HHS / United States AI69501 / AI / NIAID NIH HHS / United States M01 RR00750 / RR / NCRR NIH HHS / United States MO1RR 00095 / RR / NCRR NIH HHS / United States N01 AI72626 / AI / NIAID NIH HHS / United States P30 AI0504-10/11 / AI / NIAID NIH HHS / United States P30 AI050410 / AI / NIAID NIH HHS / United States P30-AI0450008-11 / AI / NIAID NIH HHS / United States P30AL050409 / / PHS HHS / United States R01 AI065348 / AI / NIAID NIH HHS / United States RR025780 / RR / NCRR NIH HHS / United States U01 AI027659 / AI / NIAID NIH HHS / United States U01 AI046376 / AI / NIAID NIH HHS / United States U01 AI068634 / AI / NIAID NIH HHS / United States U01 AI068636 / AI / NIAID NIH HHS / United States U01 AI069419 / AI / NIAID NIH HHS / United States U01 AI069424 / AI / NIAID NIH HHS / United States U01 AI069432 / AI / NIAID NIH HHS / United States U01 AI069452 / AI / NIAID NIH HHS / United States U01 AI069471 / AI / NIAID NIH HHS / United States U01 AI069472 / AI / NIAID NIH HHS / United States U01 AI069472-04 / AI / NIAID NIH HHS / United States U01 AI069484 / AI / NIAID NIH HHS / United States U01 AI069494 / AI / NIAID NIH HHS / United States U01 AI069501 / AI / NIAID NIH HHS / United States U01AI068636 / AI / NIAID NIH HHS / United States U01AI069495 / AI / NIAID NIH HHS / United States U01AI069511-02 / AI / NIAID NIH HHS / United States UL 1RR 025747 / RR / NCRR NIH HHS / United States UL1 RR 024160 / RR / NCRR NIH HHS / United States UL1 RR 025005 / RR / NCRR NIH HHS / United States UL1 RR024992 / RR / NCRR NIH HHS / United States UL1 RR024992 / RR / NCRR NIH HHS / United States UL1 RR024996 / RR / NCRR NIH HHS / United States UL1 RR025005. / RR / NCRR NIH HHS / United States UL1 RR025014 / RR / NCRR NIH HHS / United States UL1 RR025014 / RR / NCRR NIH HHS / United States UL1 TR000448 / TR / NCATS NIH HHS / United States UL1 TR000457 / TR / NCATS NIH HHS / United States UL1-RR033176 / RR / NCRR NIH HHS / United States UL1RR024160 / RR / NCRR NIH HHS / United States UL1RR024979 / RR / NCRR NIH HHS / United States UM1 AI069412 / AI / NIAID NIH HHS / United States UM1 AI069423 / AI / NIAID NIH HHS / United States UM1 AI069424 / AI / NIAID NIH HHS / United States UM1 AI069432 / AI / NIAID NIH HHS / United States UM1 AI069501 / AI / NIAID NIH HHS / United States UM1 AI069534 / AI / NIAID NIH HHS / United States UO1-AI069467-04 / AI / NIAID NIH HHS / United States UO1AL69418-01 / / PHS HHS / United States UOI AI 069472 / AI / NIAID NIH HHS / United States |