Loss of Bone Mineral Density After Antiretroviral Therapy Initiation "Independent of Antiretroviral Regimen"
Source: JAIDS, August 2009 - Volume 51 - Issue 5 - pp 554-56
Free abstract here.
From Conclusion: "Similar decreases in BMD over 96 weeks occurred in ART-naive subjects receiving either EFV-based regimen or LPV/r-based regimen, which was not altered by simplification to LPV/r monotherapy and was unrelated to markers of tumor necrosis factor-α activity."
Comment: But if, as many of my smartest and longest serving HIV care providers believe & observe in their (very large) practices, the biggest CULPRIT here (in terms of loss of BMD) is TENOFOVIR (as in Viread, Truvada, Atripla), this study's conclusions are not all that helpful-- as both PI and NNRTI based regimens are very likely to have included TDF+FTC (or TDF+3TC). Still, we cannot be certain until we have seen the full paper or spoken with the investigators. -MB
See also: AIDS 17-July-09 editorial, "Metabolic Bone Disease in HIV Infection"
Decreased bone mineral density with off-label use of tenofovir in children and adolescents infected with HIV-1. J Pediatr. 2008 Apr; 152(4):582-4. (link)
from AIDSmeds.com: "Viread may cause bone problems. In one clinical trial conducted by the manufacturer involving HIV-positive patients who were new to HIV therapy, Viread [combined with Sustiva and Epivir] caused decreases bone in mineral density (osteopenia) at the hip and spine."
Clinical Trial: Switch From Tenofovir to Raltegravir for Low Bone Mineral Density (link)
from aidsinfonet.org: "Tenofovir can reduce bone mineral density (see fact sheet 557). Calcium or vitamin D supplements may be helpful. This is especially true for people with osteopenia or osteoporosis." and "Use of tenofovir can also result in a loss of bone mineral." (link)
and finally, from my heroes at aidsmap.co.uk: "Vitamin D supplementation may help with tenofovir-related bone hormone deficiency" (link)
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