Bone mineral density in HIV participants randomized to raltegravir and lopinavir/ritonavir compared with standard second line therapy

Martin, Allison, Moore, Cecilia, Mallon, Patrick W. G., Hoy, Jennifer, Emery, Sean, Belloso, Waldo, Phanuphak, Praphan, Ferret, Samuel, Cooper, David A. and Boyd, Mark A. (2013) Bone mineral density in HIV participants randomized to raltegravir and lopinavir/ritonavir compared with standard second line therapy. Aids, 27 15: 2403-2411. doi:10.1097/01.aids.0000432534.47217.b4


Author Martin, Allison
Moore, Cecilia
Mallon, Patrick W. G.
Hoy, Jennifer
Emery, Sean
Belloso, Waldo
Phanuphak, Praphan
Ferret, Samuel
Cooper, David A.
Boyd, Mark A.
Title Bone mineral density in HIV participants randomized to raltegravir and lopinavir/ritonavir compared with standard second line therapy
Journal name Aids   Check publisher's open access policy
ISSN 0269-9370
1473-5571
Publication date 2013-09-24
Sub-type Article (original research)
DOI 10.1097/01.aids.0000432534.47217.b4
Open Access Status Not yet assessed
Volume 27
Issue 15
Start page 2403
End page 2411
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objective: To compare changes over 48 weeks in bone mineral density (BMD) between participants randomized to lopinavir/ritonavir (LPV/r)+raltegravir (RAL) or LPV/r + 2-3 nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTIs) as second line therapy.

Design: 48-week open-label sub-study of the Second Line trial conducted in South Africa, India, Thailand, Malaysia and Argentina.

Methods: Dual energy X-ray absorptiometry scans of proximal femur and lumbar spine were performed at baseline and week 48. Linear regression was used to compare means of differences between arms. McNemars test compared osteopenia and osteoporosis. Associations between percentage BMD changes and baseline variables were assessed by multivariate linear regression.

Results: Two hundred and ten participants were randomized. Analyses were adjusted for sex, BMI and smoking status. Mean (95% CI) proximal femur BMD% reduced over 48 weeks by -5.2% (-6.7 to -3.8%) in the LPV/r+2-3N(t)RTIs arm and by -2.9% (-4.3 to -1.5%) in the LPV/r+RAL arm (P=0.0001). Lumbar spine BMD reduced by -4.2% (-5.7 to -2.7%) in the LPV/r+2-3N(t)RTIs arm and by -2.0% (-3.5 to -0.6%) in the LPV/r+RAL arm (P=0.0006). The incidence of osteopenia (7.6%) and osteoporosis (2.0%) assessed over 48 weeks were similar between arms. Reduced BMD over 48 weeks was significantly associated with longer duration of tenofovir on study [% change (SE) -1.58 (0.38) femur, -1.65 (0.38) spine, P=0.0001] and low baseline BMI [% change (SE) 0.5 (0.13) femur, 0.17 (0.07) spine; P<0.01].

Conclusion: An N(t)RTI-sparing antiretroviral regimen of LPV/r and raltegravir as second line therapy is associated with less bone loss than a LPV/r regimen containing N(t)RTIs.
Keyword Antiretroviral therapy
Bone mineral density
HIV
Lopinavir
Raltegravir
Second line therapy
Tenofovir
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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