10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 6-8 November 2008, London, UK

BONE MINERAL MASS LOSS RISK IN HIV-INFECTED PATIENTS ON HAART: A LONGITUDINAL STUDY

Antiviral Therapy 2008; 13(Suppl. 4):A33 (abstract no. P-14)

G Madeddu¹, A Spanu², F Chessa², GM Calia¹, C Lovigu¹, M Mannazzu¹, A Falchi², D Sanna², F Cambosu¹, G Ferrandu¹, MS Mura¹, G Madeddu²

AIM: To perform a longitudinal study on bone mineral density (BMD) in a cohort of HIV-infected patients exposed to highly active antiretroviral therapy (HAART).

METHODS: In each patient, BMD (g/cm²) was measured by DEXA in the lumbar spine and femur; patients were classified according to World Health Organization criteria as normal (T-score >-1.0), osteopenic (T-score ≤-1.0 and ≥-2.5) and osteoporotic (T-score <-2.5). Serum bone alkaline phosphatase (BAP, ng/ml), as a marker of bone formation, was assayed by IRMA, and urine pyridinoline and deoxypyridinoline (PYD & DPD, nM/mM creatinine), as markers of bone resorption, was assayed by EIA. These parameters were evaluated at baseline and rechecked after 48–60 months. Patients receiving drugs affecting bone metabolism were excluded.

RESULTS: In a series of 172 adult HIV patients, 51 (27 males and 24 females) were followed in a longitudinal study. At baseline, 25/51 (49.0%) patients were heterosexuals, 21/51 (41.2%) previous intravenous drug users, 5/51 (9.8%) homosexuals, mean age was 39.5 ±6.7 years and 16/51 (23.3%) patients had previous AIDS diagnosis. Furthermore, 46/51 (90.1%) patients were HAART experienced, mean CD4+ T-cell count was 597 ±287 cells/ µl and mean HIV RNA was 4.88 ±5.48 log₁₀ copies/ml. At baseline, 8/51 (15.7%) patients were osteoporotic and 16/51 (31.4%) osteopenic in spine and/or femur, whereas 27/51 (52.9%) had normal BMD. No statistical difference was observed between the two groups in age, HAART duration, weight, femur and spine BMD, BAP and PYD & DPD. During follow-up, 27 (52.9%) patients (group 1) received protease inhibitors (PI) plus nucleoside reverse transcriptase inhibitors (NRTI) and 24 (47.1%) patients (group 2) received non-nucleoside reverse transcriptase inhibitors (NNRTI) plus NRTI or triple NRTI. No significant change in BMD values were ascertained in lumbar spine in group 1 patients, whereas BMD values had a significant (P=0.011) reduction in femur than basal values (0.86 ±0.13 versus 0.83 ±0.16 g/cm²). In group 2, mean BMD values remained unmodified in both spine and femur. In particular, 2/16 (12.5%) patients osteopenic at baseline underwent osteoporosis in the follow-up and 11/27 (40.7%) with basal normal BMD developed osteopenia in spine and/or femur. BAP levels increased in both group 1 and 2, and PYD & DPD levels increased only in group 1, but not significantly. There was no significant CD4+ T-cell count increase and HIV RNA decrease in both groups.

CONCLUSIONS: This longitudinal study demonstrates that in HIV patients on HAART a decrease of BMD, even osteoporosis, can occur. Bone mass loss, when continuing treatment, persisted over time and further worsened in some of our cases, in particular when receiving PI. Thus, a correct bone metabolism follow-up is suggested in patients on HAART, even more when other risk factors are present, to early identify those cases to be submitted to appropriate preventive treatments to reduce fracture risk.

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2008-11-06
P-14

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