9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV


19-21 July 2007, Sydney, Australia

IMPORTANT CHANGES IN BONE METABOLISM SOON AFTER COMMENCING HAART

Antiviral Therapy 2007; 12(Suppl. 2):L17 (abstract no. O-22)

E Bonnet1,2, L Mabile2, JB Ruidavets1, J Bernard1, F Marion-Latard1, L Cuzin1, F Busato1, F Lucas1, P Massip1, B Marchou1 and B Perret1,2
1University of Toulouse, Toulouse, France; 2Unité INSERM 563, Toulouse, France

AIM: To evaluate the early changes in bone metabolism in HIV-infected patients commencing HAART and to compare these changes in patients on non-nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI).

METHODS: We conducted a prospective study in HIV-naïve patients without dyslipidaemia at baseline. Biochemical parameters including bone alkaline phosphatase (BAP), osteocalcin (OCN) and β-cross-laps (β-CTx) were measured at baseline (M0) and 3, 6 and 9 months (M3, M6, M9) after starting treatment. For all patients, we also performed a dual energy X-ray absorptiometry (DXA). Bone mineral content (BMC), total bone mineral density (T BMD) and BMD of the lumbar spine (L2–L4 BMD) were measured at M0 and M9. A mixed regression model with random intercept and random slope was used to test the linear trend. Seventy-two patients were included. All patients received two NRTIs in combination with a PI (36 patients, group A) or a NNRTI (36 patients, group B).

RESULTS: Mean results are presented in Table 1.
Table 1. (Abstract O-22)
  BAP,
µg/l		 OCN,
ng/l		 β-CTx,
pg/l		 BMC, g T BMD,
g/cm2		 L2–L4 BMD,
g/cm2
M0 (n=49) 9 (+3.5) 18.6 (+6.8) 339 3,010 (+525) 1.226 (+0.101) 1.218 (+0.183)
M6 (n=46) 14 (+6.3) 28.0 (+12.7) 529  
M9 (n=40) 16.6 (+10.0) 30.6 (+12.9) 540 3,030 (+553) 1.221 (+0.107) 1.210 (+0.207)
P-value (global changes over time) 0.0002 0.0001 0.0002 0.009 0.003 0.0001
P-value (group A versus group B) 0.72 0.14 0.61 0.12 0.65 0.03

CONCLUSION: Initiating HAART in naïve patients leads to a rapid increase in all markers of bone metabolism, including those of bone formation (BAP, osteocalcin) as well as those of bone resorption (β-cross-laps). Nine months after starting HAART, the result of these changes is a significant loss of bone mineral content and bone mineral density as measured by DXA. The loss of BMD in lumbar spine seems to be greater in those patients who received PI.

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2007-07-24
O-22

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