Abstract
IntroductionPrevious studies indicate that human immunodeficiency virus (HIV)-infection and combination antiretroviral therapy (cART) can affect bone turnover. Furthermore, HIV-infected patients have lower bone mineral density (BMD) compared to a healthy reference population.ObjectiveTo evaluate the longitudinal effect of HIV-infection and cART on bone turnover markers (BTMs) and BMD in men with primary HIV-infection (PHI).Design, methodsThirty-five PHI-men were divided into two groups, those that received cART for the first time (n = 26) versus no-cART (n = 9). Dual-energy X-ray absorptiometry (DXA) was performed on femoral neck (FN), total hip (TH) and lumbar spine (LS) and BTMs (P1NP, alkaline phosphatase, osteocalcin, ICTP and CTX) were measured at baseline and follow-up.ResultsAt baseline, the median CD4+ T-cell count was 455 cells/mm3 (IQR 320–620) and plasma viral load 5.4 log10 copies/mL (IQR 4.7–6.0) in the cART treated group, compared to 630 (IQR 590–910) and 4.8 (IQR 4.2–5.1) in the untreated group. The median follow-up time was 60.7 weeks (IQR 24.7–96.0). All BTMs, except ICTP, showed a significant increase during cART versus no changes of BTMs in the untreated group. FN and TH BMD showed a significant decrease in both groups. LS BMD did not change in both groups.ConclusionBone turnover increased in PHI-men treated with cART which was accompanied by a decrease in FN and TH BMD. No increase of bone turnover was seen in untreated PHI-men. Our study suggests that cART results in increased bone turnover and decreased BMD of the hip in PHI-men.
Highlights
Previous studies indicate that human immunodeficiency virus (HIV)-infection and combination antiretroviral therapy can affect bone turnover
lumbar spine (LS) bone mineral density (BMD) did not change in both groups
Bone turnover increased in primary HIV-infection (PHI)-men treated with combination antiretroviral therapy (cART) which was accompanied by a decrease in femoral neck (FN) and total hip (TH) BMD
Summary
Patients were selected from the PRIMO-SHM trial, a prospective multicenter cohort study in PHI-men from the Amsterdam Medical Center (AMC) in Amsterdam, the Netherlands, Effect of cART versus no treatment on bone metabolism in men with primary HIV-1 infection between February 2008 and October 2009, trial number ISRCTN59497461 [10,26]. Patients were selected if they had (i) measurement of the BTMs P1NP, alkaline phosphatase (ALP), osteocalcin (OC), and/or cross-linked carboxyterminal telopeptide of type I collagen (ICTP), CTX, at baseline and/or follow-up, and (ii) DXA-scan performed at baseline and/or follow-up. Patients were excluded in case they (A) suffered from medical conditions that possibly affected bone metabolism such as hypercalcaemia or recent corticosteroid therapy for at least three months, (B) reported earlier use of cART before entering the study or (C) if they needed to (re)start cART during the study because of decreasing CD4+ T-cell counts. Of the total of 43 patients, 35 eligible patients were included in this study
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