12th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 22-25, 2005

Conf Retrovir Opportunistic Infect 2005 Feb 22-25;12:abstract no. 51a

Vania Giacomet¹, S Mora², L Cafarelli¹, P Erba¹, M Sciannamblo², and A Viganò^1
1Hosp Luigi Sacco, Milan, Italy and ²IRCCS Hosp San Raffaele, Milan, Italy

BACKGROUND: Decreased bone porosity and osteomalacia have been described in infants macaques exposed to tenofovir (TDF). Very few data in human beings are available. We assessed whether the substitution of stavudine (d4T) with tenofovir (TDF) would result in a decreased bone mineral content (BMC) and density (BMD) accrual in highly active HAART-treated HIV-infected children.

METHODS: In this prospective, longitudinal 48-month study, 13 HIV-infected children (age range 6.4 to 17.3 years) on HAART containing lamivudine (3TC) + d4T + 1 protease inhibitor (PI) (mean exposure 69 months) were switched to a 3TC/TDF/efavirenz (EFV) regimen. Changes of BMD and BMC were monitored 12 months prior to the switch (T–12), at switch (T 0), and 12 months after the switch (T+12). We included a control group of 166 healthy volunteers, ranging in age from 5.7 to 19.9 years. BMD and BMC were measured at the lumbar spine and whole skeleton by dual-energy x-ray absorptiometry. Expected changes of bone mineral measurements (accrual) were calculated from the control data and compared to those observed in HIV-infected children. Comparisons were made using paired t-tests.

RESULTS: In HIV-infected children, at T–12, T 0, and T+12, the mean lumbar spine BMC and BMD showed the following values: 24.1, 30.8 , 35.0 g and 0.81, 0.90, 0.97 g/cm², respectively. At the same intervals, the mean total body BMC and BMD showed the following values: 1380, 11703, 1917 g and 0.89, 0.99, 1.04 g/cm², respectively. From T–12 to T 0 and from T 0 to T+12, the annual increments of spine BMC and BMD observed in HIV-infected children were similar to those expected in the controls regardless of the ART regimen. From T–12 to T 0, the annual increments of total body BMC (323 g) and BMD (0.101 g/cm²) in 3TC/d4T/PI-treated HIV-infected children were higher (p = 0.05 and p = 0.0002) than those expected in the controls (256 g and 0.054 g/cm²). From T 0 to T+12 the annual increment of total body BMC (213 g) and BMD (0.040 g/cm²) in 3TC/TDF/EFV-treated HIV children were similar to those expected in the controls (190 g and 0.041 g/cm²). The annual changes on lumbar spine BMC and BMD, on total body BMC were similar between 3TC/d4T/PI- and 3TC/TDF/EFV- treated children, while the annual change on total body BMD was higher in 3TC/d4T/PI- treated children.

CONCLUSIONS: Our data indicate that, in HIV-infected children, 12-month treatment with TDF is not associated with an impairment on bone mineral accrual.

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Copyright © 2005 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.