Increased bone resorption during tenofovir plus lopinavir/ritonavir therapy in Chinese individuals with HIV.

Abstract

UNLABELLED:

We sought to evaluate the effects of antiretroviral therapy on skeletal metabolism in Chinese individuals with human immunodeficiency virus. Patients switched to tenofovir/lamivudine + lopinavir/ritonavir after treatment failure had an increase in bone resorption marker levels by nearly 60%, which is greater than the magnitude previously described in non-Chinese populations.

INTRODUCTION:

Few studies have evaluated the effects of antiretroviral therapy on skeletal metabolism in Asian populations infected with human immunodeficiency virus (HIV).

METHODS:

We performed a secondary analysis of bone turnover markers (BTM) at baseline and 2 years in stored plasma samples collected from 2/2009 to 1/2013 as part of a multi-center trial. Two groups were compared: (1) treatment-naïve patients initiated on zidovudine (AZT)/lamivudine (3TC) plus nevirapine (NVP) and (2) patients who failed first-line therapy and were switched to tenofovir (TDF)/3TC plus lopinavir/ritonavir (LPVr). Tests included the bone resorption marker, C-terminal cross-linking telopeptide of type-1 collagen (CTX), and the bone formation marker procollagen type 1 N-terminal propeptide (P1NP).

RESULTS:

In the TDF/3TC + LPVr group, samples were available from 59 patients at baseline and 56 patients at 2 years. Of these, 36 patients had samples available from both time points. In the AZT/3TC + NVP group, plasma samples were analyzed from 82 participants at baseline and of those, 61 had samples at 2 years. Median change over 2 years was greater in the TDF/3TC + LPVr group for both CTX (+0.24 ng/mL, interquartile ranges (IQR) 0.10-0.43 vs. +0.09 ng/mL, IQR -0.03 to 0.18, p = 0.001) and P1NP (+25.5 ng/mL, IQR 2.4-51.3 vs. +7.11 ng/mL, IQR -4.3 to 21.6, p = 0.012). Differences remained after adjusting for potential confounders in the multivariable analysis.

CONCLUSIONS:

Switching to TDF/3TC + LPVr after treatment failure resulted in greater increases in BTMs than initiation with AZT/3TC + NVP in Chinese patients with HIV. Following this change, bone resorption marker levels increased by nearly 60 %, which is greater than the 25-35% increase from baseline described previously in non-Chinese populations. Further studies are warranted to elucidate these findings.

• Authors: E Hsieh, L Fraenkel, W Xia, Y Y Hu, Y Han, K Insogna, M T Yin, J Xie, T Zhu, T Li
• Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (Osteoporos Int) Vol. 26 Issue 3 Pg. 1035-44 (Mar 2015) ISSN: 1433-2965 [Electronic] England
• PMID: 25224293 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-HIV Agents
• Biomarkers
• Collagen Type I
• Drug Combinations
• Peptides
• collagen type I trimeric cross-linked peptide
• lopinavir-ritonavir drug combination
• Lopinavir
• Tenofovir
• Ritonavir

Topics

• Adolescent
• Adult
• Aged
• Anti-HIV Agents (adverse effects, therapeutic use)
• Biomarkers (blood)
• Bone Remodeling (drug effects)
• Bone Resorption (blood, chemically induced)
• Collagen Type I (blood)
• Drug Combinations
• Drug Substitution
• Drug Therapy, Combination
• Female
• HIV Infections (blood, drug therapy)
• HIV-1
• Humans
• Lopinavir (adverse effects, therapeutic use)
• Male
• Middle Aged
• Peptides (blood)
• Ritonavir (adverse effects, therapeutic use)
• Tenofovir (adverse effects, therapeutic use)
• Young Adult