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. 2017 May 15;64(10):1413-1421.
doi: 10.1093/cid/cix167.

Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort

Álvaro H Borges  1   2 , Jennifer Hoy  3 , Eric Florence  4 , Dalibor Sedlacek  5 , Hans-Jürgen Stellbrink  6 , Vilma Uzdaviniene  7 , Janez Tomazic  8 , Panagiotis Gargalianos-Kakolyris  9 , Patrick Schmid  10 , Chloe Orkin  11 , Court Pedersen  12 , Clifford Leen  13 , Christian Pradier  14 , Fiona Mulcahy  15 , Anna Lisa Ridolfo  16 , Therese Staub  17 , Fernando Maltez  18 , Rainer Weber  19 , Leo Flamholc  20 , Galina Kyselyova  21 , Jens D Lundgren  1 , Amanda Mocroft  22 ; for EuroSIDA
Affiliations

Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort

Álvaro H Borges et al. Clin Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Clin Infect Dis. 2017 Oct 15;65(8):1431-1433. doi: 10.1093/cid/cix563. Clin Infect Dis. 2017. PMID: 29017252 Free PMC article. No abstract available.

Abstract

Background: Antiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes.

Methods: EuroSIDA participants were followed to assess fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed.

Results: During 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70.4% virologically suppressed), there were 619 fractures (incidence/1000 PYFU 7.2; 95% CI 6.6-7.7) and 89 osteonecrosis (1.0; 0.8-1.3). Older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV coinfection, prior osteonecrosis, prior fracture, cardiovascular disease, and recent non-AIDS cancer (last 12 months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y exposure; 0.94-1.25). No other ARV was associated with fractures (all P > .1). Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture, and prior AIDS. After mutual adjustment, no ARV was associated with osteonecrosis.

Conclusions: In human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures.

Keywords: HIV.; avascular necrosis; bone; fractures; osteonecrosis.

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