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. 2012 Nov 13;26(17):2175-84.
doi: 10.1097/QAD.0b013e328359a8ca.

Fractures after antiretroviral initiation

Michael T Yin  1 , Michelle A Kendall, Xingye Wu, Katherine Tassiopoulos, Marc Hochberg, Jeannie S Huang, Marshall J Glesby, Hector Bolivar, Grace A McComsey
Affiliations

Fractures after antiretroviral initiation

Michael T Yin et al. AIDS. .

Abstract

Background: Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates.

Methods: We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence.

Results: Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals.

Conclusion: Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.

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Conflict of interest statement

Conflicts of interest

M.T.Y has served as a consultant for Gilead and received research grants from Gilead and Bristol Myers Squibb. M.A.K., X.W., and K.T. have no conflicts of interest. M.C.H. has served as a consultant for Abbot, Bristol Myers Squibb, Roche, Merck, and Pfizer. J.S.H. has no conflicts of interest. M.A.G. has served as a consultant for Gilead, SIGA and Pfizer. H.B. has no conflicts of interest. G.A.M. has served as a scientific advisor or speaker for Bristol Myers Squibb, GlaxoSmithKline, Tibotec, and Gilead Science, has received research grants from Bristol Myers Squibb, GlaxoSmithKline, and Gilead Sciences, and is currently serving as the DSMB Chair for a Pfizer-sponsored study.

Figures

Fig. 1
Fig. 1. Time-to-first fracture from antiretroviral therapy initiation in 3398 antiretroviral therapy-naive participants
ART, antiretroviral therapy.
Fig. 2
Fig. 2. Fracture incidence rates (and 95% confidence intervals) by time since antiretroviral therapy initiation in 3398 ART-naive participants
Bar widths are proportional to the number of participants. ART, antiretroviral therapy; PY, person-years.
See this image and copyright information in PMC

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