Effect of antiretroviral therapy on bone turnover and bone mineral density in men with primary HIV-1 infection

Mariska C Vlot; Marlous L Grijsen; Jan M Prins; Renate T de Jongh; Robert de Jonge; Martin den Heijer; Annemieke C Heijboer

doi:10.1371/journal.pone.0193679

Effect of antiretroviral therapy on bone turnover and bone mineral density in men with primary HIV-1 infection

PLoS One. 2018 Mar 9;13(3):e0193679. doi: 10.1371/journal.pone.0193679. eCollection 2018.

Authors

Mariska C Vlot^{1

2}, Marlous L Grijsen^{3

4}, Jan M Prins³, Renate T de Jongh², Robert de Jonge¹, Martin den Heijer², Annemieke C Heijboer^{1

5}

Affiliations

¹ Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, the Netherlands.
² Department of Internal Medicine, Endocrinology, VU University Medical Center, Amsterdam, the Netherlands.
³ Department of Internal Medicine, Infectious Diseases, Center for Infection and Immunity, Academic Medical Center, Amsterdam, the Netherlands.
⁴ Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.
⁵ Department of Clinical Chemistry, Endocrine laboratory, Academic Medical Center, Amsterdam, the Netherlands.

Abstract

Introduction: Previous 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.

Objective: To evaluate the longitudinal effect of HIV-infection and cART on bone turnover markers (BTMs) and BMD in men with primary HIV-infection (PHI).

Design, methods: Thirty-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.

Results: At 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.

Conclusion: Bone 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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anti-HIV Agents / pharmacology*
Anti-HIV Agents / therapeutic use
Bone Density / drug effects*
Bone Remodeling / drug effects*
Female
HIV Infections / drug therapy
HIV Infections / physiopathology*
HIV-1 / physiology*
Humans
Male

Substances

Anti-HIV Agents

Grants and funding

This work was supported by an unrestricted grant from Abbott diagnostics (Chicago, IL, United States of America) to MV and AH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.