The progression of
acquired immunodeficiency syndrome is delayed in patients with human immunodeficiency virus (
HIV) infection receiving antiretroviral
therapy (ART). However, long-term ART is associated with adverse effects.
Osteoporosis is one of the adverse effects and is a multifactorial systemic skeletal disease associated with bone fragility and an increased risk of fracture. We performed a longitudinal, comprehensive, nested case-control study to explore the effect of ART on the risk of
osteoporosis in 104 osteoporotic and 416 non-osteoporotic patients with
HIV infection at their average age about 29 years old in Taiwan. Patients with history of ART, current exposure to ART, higher cumulative defined daily doses (DDDs), or higher ART adherence were at a higher risk of
osteoporosis (p < 0.05). Patients receiving
nucleoside/
nucleotide reverse transcriptase inhibitor (NRTI)-containing regimen (
zidovudine-
lamivudine combination,
lamivudine-
abacavir combination, and
abacavir alone) and
protease inhibitor (PI)-containing regimen (
lopinavir-
ritonavir combination,
ritonavir, and
atazanavir) had a higher risk of
osteoporosis (p < 0.05). Especially, patients receiving high doses of the PIs
lopinavir-
ritonavir combination had an increased risk of
osteoporosis (p < 0.05). In conclusion, history of ART, current exposure to ART, higher cumulative DDDs, and higher ART adherence were associated with an increased risk of
osteoporosis. Furthermore, NRTI- and PI-containing regimens and high doses of PIs
lopinavir-
ritonavir combination may be associated with an increased risk of
osteoporosis in patients with
HIV infection in Taiwan.