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Randomized Controlled Trial
. 2013 Nov;57(10):1483-8.
doi: 10.1093/cid/cit538. Epub 2013 Aug 13.

Low baseline CD4+ count is associated with greater bone mineral density loss after antiretroviral therapy initiation

Philip M Grant  1 , Douglas Kitch, Grace A McComsey, Michael P Dube, Richard Haubrich, Jeannie Huang, Sharon Riddler, Pablo Tebas, Andrew R Zolopa, Ann C Collier, Todd T Brown
Affiliations
Randomized Controlled Trial

Low baseline CD4+ count is associated with greater bone mineral density loss after antiretroviral therapy initiation

Philip M Grant et al. Clin Infect Dis. 2013 Nov.

Abstract

Background: Bone mineral density (BMD) decreases 2%-6% in the 2 years after antiretroviral therapy (ART) initiation. Pre-ART immune deficiency and early immune recovery may contribute to this loss.

Methods: We pooled data from 3 studies of ART initiation in treatment-naive patients in which serial whole-body dual-energy X-ray absorptiometry scans were performed. We used linear regression to evaluate effects of baseline CD4(+) and 16-week CD4(+) change (both absolute and relative) on 96-week total BMD change from baseline. We performed multivariable linear regression to assess associations between baseline variables of age, sex, race/ethnicity, body mass index (BMI), hepatitis C status, parent study, human immunodeficiency virus type 1 (HIV-1) RNA level, and assignment to a protease inhibitor (PI)- or tenofovir-containing regimen on 96-week total BMD change.

Results: The included 796 subjects had mean 96-week total BMD loss of 2.0%. In multivariable analysis, baseline CD4(+) cell count was significantly associated with 96-week BMD loss; individuals with baseline CD4(+) <50 cells/µL lost significantly more BMD compared to those with CD4(+) ≥500 cells/µL. A greater relative, but not absolute, 16-week increase in CD4(+) count was significantly associated with greater declines in BMD, but not after controlling for baseline CD4(+) count. In multivariable analysis, older age, female sex, lower BMI, higher HIV-1 RNA levels, and PI and tenofovir assignment were also associated with greater BMD decline.

Conclusions: Low pretreatment CD4(+) count, but not greater CD4(+) count increase, is a strong and independent risk factor for bone loss after ART initiation. ART initiation at higher CD4(+) counts may reduce the burden of osteoporosis and fragility fractures.

Keywords: HIV infections; administration and dosage; anti-HIV agents; bone density; drug therapy/virology.

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Figures

Figure 1.
Figure 1.
Week 96 bone mineral density (BMD) change by baseline CD4+ cell count category. Thick black lines indicate the group mean.
See this image and copyright information in PMC

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