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Low CD4+ count risk factor for bone loss after ART
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A CD4+ cell count of less than 50 cells/mcL before starting treatment is an independent risk factor for bone lost after initiation of antiretroviral therapy, according to study results published in Clinical Infectious Diseases.
“There has been some uncertainty related to the relationship between baseline immunosuppression and bone loss,” Philip Grant, MD, of the division of infectious diseases and geographic medicine at Stanford University, told Infectious Disease News. “Delaying ART has many negative consequences, including an increase risk for bone loss and fractures. However, a good response to ART did not seem to lead to increased bone loss.”
Grant and colleagues used data from three studies in which treatment-naive patients with HIV underwent whole-body dual X-ray absorptiometry (DXA) at baseline and at 96 weeks after ART initiation. They assessed changes based on whole-body bone mineral density (BMD). This analysis included 796 patients who had baseline and 96-week DXA evaluations.
The mean 96-week BMD loss was 2%. Baseline CD4+ cell count was associated with BMD loss. Those who initiated ART with a CD4+ cell count of less than 50 cells/mcL lost 3% more BMD (95% CI, –4 to –2) than those who initiated ART with a CD4+ cell count of at least 500 cells/mcL. In a multivariable analysis, older age, female sex, lower BMI, higher HIV RNA levels and the use of protease inhibitors and tenofovir were also associated with BMD decline.
“These data provide additional impetus for early ART,” Grant said. “Other groups, including women, older individuals and individuals receiving tenofovir- or protease inhibitor-containing regimens are also at increased risk for bone loss, and BMD should be followed more closely in these groups.”
Grant said further studies are needed to define the optimal management of bone health in HIV, such as the medications to use and who should be screened.
Philip Grant, MD, can be reached at the Division of Infectious Diseases and Geographic Medicine, Stanford University, 300 Pasteur Drive, Room S-101, Stanford, CA 94305-5107; email: pmgrant@stanford.edu.
Disclosure: The researchers report financial relationships with Abbott, Bristol-Myers Squibb, EMD-Serono, Gilead, GlaxoSmithKline, Janssen, Johnson & Johnson, Merck, Pfizer, Schering-Plough and ViiV Healthcare.
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