BACKGROUND: Lower peak bone mass in early adulthood predicts subsequent fragility fractures. Antiretroviral toxicity could contribute to young HIV-infected individuals not achieving adequate peak bone mass. OBJECTIVE: To determine if tenofovir disoproxil fumarate's (TDF) effect on bone mineral density (BMD) differs by age. METHODS: We examined BMD data at the lumbar spine and hip from AIDS Clinical Trials Group (ACTG) A5224s and ASSERT and randomized treatment-naive studies comparing TDF/emtricitabine versus abacavir/lamivudine (with efavirenz or atazanavir/ritonavir). In this post hoc analysis, we defined the TDF effect as the difference between mean 48-week BMD per cent changes for lumbar spine and hip in individuals randomized to TDF versus abacavir. We used multivariable linear regression to compare the TDF effect in individuals younger and older than 30 years. If TDF effect by age did not differ significantly between studies, we pooled study populations. Otherwise, analyses were conducted separately within each study population. RESULTS: Among 652 subjects, 21% were below age 30 years. The relationship between age and TDF effect significantly differed between A5224s and ASSERT (P = 0.008 for lumbar spine; P = 0.007 for hip). In A5224s, there was more bone loss with TDF at lumbar spine and hip in subjects under 30 years old versus in older subjects ( - 4.5% vs - 1.4%; P = 0.045; - 4.3% vs - 1.6%; P = 0.026, respectively). There was no significant evidence for this age-associated TDF effect in ASSERT. CONCLUSIONS: There was heterogeneity in the observed effect of TDF on bone density in young adults compared to older adults, suggesting that further investigation is required to understand the impact of age on BMD decline with TDF.
RCT Entities:
BACKGROUND: Lower peak bone mass in early adulthood predicts subsequent fragility fractures. Antiretroviral toxicity could contribute to young HIV-infected individuals not achieving adequate peak bone mass. OBJECTIVE: To determine if tenofovir disoproxil fumarate's (TDF) effect on bone mineral density (BMD) differs by age. METHODS: We examined BMD data at the lumbar spine and hip from AIDS Clinical Trials Group (ACTG) A5224s and ASSERT and randomized treatment-naive studies comparing TDF/emtricitabine versus abacavir/lamivudine (with efavirenz or atazanavir/ritonavir). In this post hoc analysis, we defined the TDF effect as the difference between mean 48-week BMD per cent changes for lumbar spine and hip in individuals randomized to TDF versus abacavir. We used multivariable linear regression to compare the TDF effect in individuals younger and older than 30 years. If TDF effect by age did not differ significantly between studies, we pooled study populations. Otherwise, analyses were conducted separately within each study population. RESULTS: Among 652 subjects, 21% were below age 30 years. The relationship between age and TDF effect significantly differed between A5224s and ASSERT (P = 0.008 for lumbar spine; P = 0.007 for hip). In A5224s, there was more bone loss with TDF at lumbar spine and hip in subjects under 30 years old versus in older subjects ( - 4.5% vs - 1.4%; P = 0.045; - 4.3% vs - 1.6%; P = 0.026, respectively). There was no significant evidence for this age-associated TDF effect in ASSERT. CONCLUSIONS: There was heterogeneity in the observed effect of TDF on bone density in young adults compared to older adults, suggesting that further investigation is required to understand the impact of age on BMD decline with TDF.
Entities:
Keywords:
Anti-HIV agents,; Bone density; HIV infections,; administration and dosage,; adverse effects,; drug therapy/virology,
Authors: Philip M Grant; Douglas Kitch; Grace A McComsey; Michael P Dube; Richard Haubrich; Jeannie Huang; Sharon Riddler; Pablo Tebas; Andrew R Zolopa; Ann C Collier; Todd T Brown Journal: Clin Infect Dis Date: 2013-08-13 Impact factor: 9.079
Authors: Michael T Yin; Emily Lund; Jayesh Shah; Chiyuan A Zhang; Marc Foca; Natalie Neu; Kyle K Nishiyama; Bin Zhou; Xiangdong E Guo; John Nelson; David L Bell; Elizabeth Shane; Stephen M Arpadi Journal: AIDS Date: 2014-01-28 Impact factor: 4.177
Authors: Marit G A van Vonderen; Paul Lips; Michiel A van Agtmael; Elly A M Hassink; Kees Brinkman; Suzanne E Geerlings; Jussi Sutinen; Matti Ristola; Sven A Danner; Peter Reiss Journal: AIDS Date: 2009-07-17 Impact factor: 4.177
Authors: José R Valdez Madruga; Isabel Cassetti; Jamal Muhamad A H Suleiman; Arnaldo Etzel; Lijie Zhong; Charles B Holmes; Andrew K Cheng; Jeffrey Enejosa Journal: HIV Clin Trials Date: 2007 Nov-Dec
Authors: Michael T Yin; Michelle A Kendall; Xingye Wu; Katherine Tassiopoulos; Marc Hochberg; Jeannie S Huang; Marshall J Glesby; Hector Bolivar; Grace A McComsey Journal: AIDS Date: 2012-11-13 Impact factor: 4.177
Authors: Todd T Brown; Grace A McComsey; Martin S King; Roula B Qaqish; Barry M Bernstein; Barbara A da Silva Journal: J Acquir Immune Defic Syndr Date: 2009-08-15 Impact factor: 3.771
Authors: Joanne LaFleur; Adam P Bress; Joel Myers; Lisa Rosenblatt; Jacob Crook; Kristin Knippenberg; Roger Bedimo; Pablo Tebas; Heather Nyman; Stephen Esker Journal: Infect Dis Ther Date: 2018-02-28