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Longitudinal change in bone mineral density among Chinese individuals with HIV after initiation of antiretroviral therapy

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Abstract

Summary

This is the first study to report changes in BMD and related risk factors among Chinese patients with HIV after initiation of tenofovir disoproxil fumarate (TDF)-containing antiretroviral therapy. Greater bone mineral density (BMD) loss was observed in patients treated with TDF, compared to those on non-TDF-containing regimens. Our findings provide important knowledge regarding the risk factors in the long-term clinical management of patients with HIV in China.

Introduction

Persons living with HIV (PLWH) are at increased risk for osteoporosis and fracture. Tenofovir disoproxil fumarate (TDF) has been associated with higher rates of bone mineral density (BMD) loss, osteoporosis, and fracture. Few studies have studied the impact among PLWH in Asia.

Methods

We analyzed retrospectively patients from the outpatient HIV clinic of a large tertiary hospital in Beijing, China, from March 2007 to May 2016. Patients who had dual-energy X-ray absorptiometry testing prior to antiretroviral initiation and at 48 and/or 96 weeks after initiation were included in this analysis.

Results

A total of 136 patients were included (mean age 36.0 ± 10.6 years) and over 90% participants were male and Han Chinese ethnicity. We observed greater declines in BMD at the spine from baseline to week 48 (−2.94% vs. −0.74%) and at the hip from baseline to week 96 (−4.37% vs. −2.34%) in the TDF group compared with the non-TDF group. With regard to HIV-specific parameters, longer duration since HIV diagnosis and undetectable viral load over time were associated with lower BMD at the hip [relative risk (RR) 0.97, 95% confidence index (CI) (0.95, 0.99) per 1 year increase and RR 0.96, 95%CI (0.94, 0.99), respectively] and femoral neck [RR 0.97, 95%CI (0.95, 0.99) per 1 year increase and RR 0.97, 95%CI (0.95, 0.998), respectively] over 96 weeks.

Conclusions

This is the first study to report changes in BMD among PLWH after initiation of TDF-based antiretroviral therapy in China. Our findings provide important knowledge for the long-term clinical management of PLWH from this region.

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Acknowledgements

We thank the patients and their families for their participation and support during this study. This study was funded by the National Key Technologies Research & Development Program for the 13th Five-year Plan (2017ZX10202101) and Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CAMS-12M) (2017-12M-1-014). Dr. Hsieh is supported by NIH/Fogarty International Center K01TW009995 and the Rheumatology Research Foundation.

Funding

This study was funded by the National Key Technologies Research & Development Program for the 13th Five-year Plan (2017ZX10202101) and Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CAMS-12M) (2017-12M-1-014). Dr. Hsieh is supported by NIH/Fogarty International Center K01TW009995.

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Authors and Affiliations

  1. Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China

    F. Guo, X. Song, Y. Li, W. Pan, T. Li & E. Hsieh

  2. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China

    W. Guan & W. Yu

  3. Center for AIDS Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    T. Li

  4. Section of Rheumatology, Allergy, and Clinical Immunology, Yale School of Medicine, 300 Cedar Street, TAC S-525, PO Box 208031, New Haven, CT, 06517, USA

    E. Hsieh

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Guo, F., Song, X., Li, Y. et al. Longitudinal change in bone mineral density among Chinese individuals with HIV after initiation of antiretroviral therapy. Osteoporos Int 32, 321–332 (2021). https://doi.org/10.1007/s00198-020-05584-w

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