Associations between vitamin D metabolites, antiretroviral therapy and bone mineral density in people with HIV

Klassen, K. M., Kimlin, M. G., Fairley, C. K., Emery, S., Anderson, P. H. and Ebeling, P. R. (2016) Associations between vitamin D metabolites, antiretroviral therapy and bone mineral density in people with HIV. Osteoporosis International, 27 5: 1737-1745. doi:10.1007/s00198-015-3432-3


Author Klassen, K. M.
Kimlin, M. G.
Fairley, C. K.
Emery, S.
Anderson, P. H.
Ebeling, P. R.
Title Associations between vitamin D metabolites, antiretroviral therapy and bone mineral density in people with HIV
Journal name Osteoporosis International   Check publisher's open access policy
ISSN 1433-2965
0937-941X
Publication date 2016-05-01
Year available 2016
Sub-type Article (original research)
DOI 10.1007/s00198-015-3432-3
Open Access Status Not yet assessed
Volume 27
Issue 5
Start page 1737
End page 1745
Total pages 9
Place of publication London, United Kingdom
Publisher Springer U K
Collection year 2017
Language eng
Formatted abstract
Rationale: To see if vitamin D and antiretroviral therapy are associated with bone mineral density (BMD) in people with HIV. Result: Lower hip BMD was associated with tenofovir (an antiretroviral medicine) in those with 25(OH)D ≥50 nmol/L. Significance: The relationship between antiretroviral therapy and hip BMD differs depending on vitamin D status.

Introduction
People with HIV have an increased risk of low BMD and fractures. Antiretroviral therapy contributes to this increased risk.

The aim of this study was to evaluate associations between vitamin D metabolites and antiretroviral therapy on BMD.

Methods
The simplification of antiretroviral therapy with tenofovir-emtricitabine or abacavir-lamivudine trial (STEAL) was an open-label, prospective randomised non-inferiority study that compared simplification of current nucleoside reverse transcriptase inhibitors (NRTIs) to fixed-dose combination tenofovir-emtricitabine (TDF-FTC) or abacavir-lamivudine. Serum 25(OH)D and 1,25(OH)2D were measured in 160 individuals (90 receiving TDF-FTC, 70 receiving other NRTIs) at baseline from this study. Multivariable linear regression models were constructed to evaluate the covariates of 1,25(OH)2D and BMD.

Results
Protease inhibitor use (p = 0.02) and higher body mass index (BMI) (p = 0.002) were associated with lower 1,25(OH)2D levels in those with 25(OH)D <50 nmol/L. However, TDF-FTC use (p = 0.01) was associated with higher 1,25(OH)2D levels, but only in those with 25(OH)D ≥50 nmol/L.

White ethnicity (p = 0.02) and lower BMI (p < 0.001) in those with 25(OH)D <50 nmol/L and with TDF-FTC use (p = 0.008) in those with 25(OH)D ≥50 nmol/L were associated with lower hip BMD. TDF-FTC use, higher serum calcium and serum βCTX, winter, and lower bone-specific alkaline phosphatase (BALP) and BMI were associated with lower lumbar spine BMD.

Conclusion
TDF-FTC use (versus non-TDF-FTC use) was associated with lower hip BMD, and this difference was more pronounced in those with 25(OH)D ≥50 nmol/L. Serum 25(OH)D <50 nmol/L was associated with lower hip BMD in all participants. Therefore, the associations between antiretroviral therapy and hip BMD differ depending on vitamin D status.
Keyword Antiretroviral therapy
Bone
HIV
Vitamin D
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Faculty of Medicine
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 0 times in Thomson Reuters Web of Science Article
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Sat, 18 Mar 2017, 01:00:47 EST by Web Cron on behalf of Learning and Research Services (UQ Library)