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Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort

2017Journal article Open access
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dc.contributor.authorBorges, A
dc.contributor.authorHoy, J
dc.contributor.authorFlorence, E
dc.contributor.authorSedlacek, D
dc.contributor.authorStellbrink, HJ
dc.contributor.authorUzdaviniene, V
dc.contributor.authorTomazic, J
dc.contributor.authorGargalianos-Kakolyris, P
dc.contributor.authorSchmid, P
dc.contributor.authorOrkin, C
dc.contributor.authorPedersen, C
dc.contributor.authorLeen, C
dc.contributor.authorPradier, C
dc.contributor.authorMulcahy, F
dc.contributor.authorRidolfo, A
dc.contributor.authorStaub, T
dc.contributor.authorMaltez, F
dc.contributor.authorWeber, R
dc.contributor.authorFlamholc, L
dc.contributor.authorKyselyova, G
dc.contributor.authorLungren, J
dc.contributor.authorMocroft, A
dc.contributor.authorEuroSIDA
dc.date.accessioned2021-10-04T11:41:22Z
dc.date.available2021-10-04T11:41:22Z
dc.date.issued2017
dc.description.abstractBackground: Antiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes. Methods: EuroSIDA participants were followed to assess fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed. Results: During 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70.4% virologically suppressed), there were 619 fractures (incidence/1000 PYFU 7.2; 95% CI 6.6-7.7) and 89 osteonecrosis (1.0; 0.8-1.3). Older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV coinfection, prior osteonecrosis, prior fracture, cardiovascular disease, and recent non-AIDS cancer (last 12 months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y exposure; 0.94-1.25). No other ARV was associated with fractures (all P > .1). Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture, and prior AIDS. After mutual adjustment, no ARV was associated with osteonecrosis. Conclusions: In human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationClin Infect Dis. 2017 May 15;64(10):1413-1421.pt_PT
dc.identifier.doi10.1093/cid/cix167.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3861
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherOxfordpt_PT
dc.subjectHCC INFpt_PT
dc.subjectAdultpt_PT
dc.subjectFemalept_PT
dc.subjectMalept_PT
dc.subjectHumanspt_PT
dc.subjectAnti-HIV Agents / administration & dosagept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectAnti-HIV Agents / adverse effectspt_PT
dc.subjectAnti-HIV Agents / therapeutic usept_PT
dc.subjectBone Density / drug effectspt_PT
dc.subjectCD4 Lymphocyte Countpt_PT
dc.subjectCohort Studiespt_PT
dc.subjectCoinfection / epidemiologypt_PT
dc.subjectData Collectionpt_PT
dc.subjectEurope / epidemiologypt_PT
dc.subjectFemoral Fractures / epidemiologypt_PT
dc.subjectFemoral Fractures / etiologypt_PT
dc.subjectFemoral Fractures / virologypt_PT
dc.subjectFractures, Bone / epidemiologypt_PT
dc.subjectFractures, Bone / ethnologypt_PT
dc.subjectFractures, Bone / etiologypt_PT
dc.subjectFractures, Bone / virologypt_PT
dc.subjectHIV Infections / complicationspt_PT
dc.subjectHIV Infections / drug therapypt_PT
dc.subjectHIV Infections / epidemiologypt_PT
dc.subjectHIV Infections / virologypt_PT
dc.subjectOsteonecrosis / epidemiologypt_PT
dc.subjectOsteonecrosis / etiologypt_PT
dc.subjectOsteonecrosis / virologypt_PT
dc.subjectRegression Analysispt_PT
dc.subjectRisk Factorspt_PT
dc.subjectTenofovir / adverse effectspt_PT
dc.subjectTenofovir / therapeutic usept_PT
dc.titleAntiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohortpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1421pt_PT
oaire.citation.startPage1413pt_PT
oaire.citation.titleClinical Infectious Diseasespt_PT
oaire.citation.volume64pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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