Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy.

Abstract

We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm3. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.

• Authors: Camille Couffignal, Sami Kolta, Martin Flamant, Charles Cazanave, Jean-Philippe Haymann, France Mentré, Xavier Duval, Catherine Leport, François Raffi, APROCO-COPILOTE ANRS CO8 Study Group
• Journal: AIDS research and human retroviruses (AIDS Res Hum Retroviruses) Vol. 36 Issue 5 Pg. 399-405 (05 2020) ISSN: 1931-8405 [Electronic] United States
• PMID: 31891665 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Reverse Transcriptase Inhibitors
• Nevirapine

Topics

• Absorptiometry, Photon
• Adult
• Bone Density (drug effects)
• Cross-Sectional Studies
• Female
• Follow-Up Studies
• HIV Infections (complications, drug therapy)
• HIV-1 (drug effects)
• Humans
• Male
• Middle Aged
• Nevirapine (therapeutic use)
• Prospective Studies
• Reverse Transcriptase Inhibitors (therapeutic use)
• Time Factors