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

Identifieur interne : 000C36 ( PubMed/Corpus ); précédent : 000C35; suivant : 000C37

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

Auteurs : Álvaro H. Borges ; Jennifer Hoy ; Eric Florence ; Dalibor Sedlacek ; Hans-Jürgen Stellbrink ; Vilma Uzdaviniene ; Janez Tomazic ; Panagiotis Gargalianos-Kakolyris ; Patrick Schmid ; Chloe Orkin ; Court Pedersen ; Clifford Leen ; Christian Pradier ; Fiona Mulcahy ; Anna Lisa Ridolfo ; Therese Staub ; Fernando Maltez ; Rainer Weber ; Leo Flamholc ; Galina Kyselyova ; Jens D. Lundgren ; Amanda Mocroft

Source :

RBID : pubmed:28329090

Abstract

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.

DOI: 10.1093/cid/cix167
PubMed: 28329090

Links to Exploration step

pubmed:28329090

Le document en format XML

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<name sortKey="Kyselyova, Galina" sort="Kyselyova, Galina" uniqKey="Kyselyova G" first="Galina" last="Kyselyova">Galina Kyselyova</name>
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<name sortKey="Gargalianos Kakolyris, Panagiotis" sort="Gargalianos Kakolyris, Panagiotis" uniqKey="Gargalianos Kakolyris P" first="Panagiotis" last="Gargalianos-Kakolyris">Panagiotis Gargalianos-Kakolyris</name>
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<nlm:affiliation>The General Hospital of Athens "G. Gennimatas" First Department Of Medicine - Infectious Diseases Unit, Athens, Greece.</nlm:affiliation>
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<name sortKey="Schmid, Patrick" sort="Schmid, Patrick" uniqKey="Schmid P" first="Patrick" last="Schmid">Patrick Schmid</name>
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<nlm:affiliation>Division of Infectious Diseases, Cantonal Hospital St. Gallen, Switzerland.</nlm:affiliation>
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<name sortKey="Orkin, Chloe" sort="Orkin, Chloe" uniqKey="Orkin C" first="Chloe" last="Orkin">Chloe Orkin</name>
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<name sortKey="Pedersen, Court" sort="Pedersen, Court" uniqKey="Pedersen C" first="Court" last="Pedersen">Court Pedersen</name>
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<nlm:affiliation>Odense Universitetshospital, Forskningsenheden, Denmark.</nlm:affiliation>
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<name sortKey="Leen, Clifford" sort="Leen, Clifford" uniqKey="Leen C" first="Clifford" last="Leen">Clifford Leen</name>
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<nlm:affiliation>Western General Hospital, Edinburgh, United Kingdom.</nlm:affiliation>
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<name sortKey="Pradier, Christian" sort="Pradier, Christian" uniqKey="Pradier C" first="Christian" last="Pradier">Christian Pradier</name>
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<nlm:affiliation>CHU Nice Hopital de l' Archet 1, Nice, France.</nlm:affiliation>
</affiliation>
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<name sortKey="Mulcahy, Fiona" sort="Mulcahy, Fiona" uniqKey="Mulcahy F" first="Fiona" last="Mulcahy">Fiona Mulcahy</name>
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<nlm:affiliation>St. James' Hospital, Dublin, Ireland.</nlm:affiliation>
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<name sortKey="Ridolfo, Anna Lisa" sort="Ridolfo, Anna Lisa" uniqKey="Ridolfo A" first="Anna Lisa" last="Ridolfo">Anna Lisa Ridolfo</name>
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<nlm:affiliation>Ospedale L. Sacco, Milan, Italy.</nlm:affiliation>
</affiliation>
</author>
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<name sortKey="Staub, Therese" sort="Staub, Therese" uniqKey="Staub T" first="Therese" last="Staub">Therese Staub</name>
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<nlm:affiliation>Centre Hospitalier de Luxembourg, Luxemborg.</nlm:affiliation>
</affiliation>
</author>
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<name sortKey="Maltez, Fernando" sort="Maltez, Fernando" uniqKey="Maltez F" first="Fernando" last="Maltez">Fernando Maltez</name>
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<nlm:affiliation>Hospital Curry Cabral, Lisbon, Portugal.</nlm:affiliation>
</affiliation>
</author>
<author>
<name sortKey="Weber, Rainer" sort="Weber, Rainer" uniqKey="Weber R" first="Rainer" last="Weber">Rainer Weber</name>
<affiliation>
<nlm:affiliation>University Hospital Zürich, Switzerland.</nlm:affiliation>
</affiliation>
</author>
<author>
<name sortKey="Flamholc, Leo" sort="Flamholc, Leo" uniqKey="Flamholc L" first="Leo" last="Flamholc">Leo Flamholc</name>
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<nlm:affiliation>Skåne University Hospital, Malmö, Sweden.</nlm:affiliation>
</affiliation>
</author>
<author>
<name sortKey="Kyselyova, Galina" sort="Kyselyova, Galina" uniqKey="Kyselyova G" first="Galina" last="Kyselyova">Galina Kyselyova</name>
<affiliation>
<nlm:affiliation>Crimean Republican AIDS Centre, Simferopol, Ukraine; and.</nlm:affiliation>
</affiliation>
</author>
<author>
<name sortKey="Lundgren, Jens D" sort="Lundgren, Jens D" uniqKey="Lundgren J" first="Jens D" last="Lundgren">Jens D. Lundgren</name>
<affiliation>
<nlm:affiliation>Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, and.</nlm:affiliation>
</affiliation>
</author>
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<name sortKey="Mocroft, Amanda" sort="Mocroft, Amanda" uniqKey="Mocroft A" first="Amanda" last="Mocroft">Amanda Mocroft</name>
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<nlm:affiliation>Department of Infection and Population Health, University College London, UK.</nlm:affiliation>
</affiliation>
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<title level="j">Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</title>
<idno type="eISSN">1537-6591</idno>
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<date when="2017" type="published">2017</date>
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<div type="abstract" xml:lang="en">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.</div>
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<DateCreated>
<Year>2017</Year>
<Month>03</Month>
<Day>22</Day>
</DateCreated>
<DateRevised>
<Year>2017</Year>
<Month>05</Month>
<Day>05</Day>
</DateRevised>
<Article PubModel="Print">
<Journal>
<ISSN IssnType="Electronic">1537-6591</ISSN>
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<Volume>64</Volume>
<Issue>10</Issue>
<PubDate>
<Year>2017</Year>
<Month>May</Month>
<Day>15</Day>
</PubDate>
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<Title>Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</Title>
<ISOAbbreviation>Clin. Infect. Dis.</ISOAbbreviation>
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<ArticleTitle>Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort.</ArticleTitle>
<Pagination>
<MedlinePgn>1413-1421</MedlinePgn>
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<Abstract>
<AbstractText Label="Background" NlmCategory="UNASSIGNED">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.</AbstractText>
<AbstractText Label="Methods" NlmCategory="UNASSIGNED">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.</AbstractText>
<AbstractText Label="Results" NlmCategory="UNASSIGNED">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.</AbstractText>
<AbstractText Label="Conclusions" NlmCategory="UNASSIGNED">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.</AbstractText>
</Abstract>
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<LastName>Borges</LastName>
<ForeName>Álvaro H</ForeName>
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<Affiliation>Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, and.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Institute for Clinical Medicine, University of Copenhagen, Denmark.</Affiliation>
</AffiliationInfo>
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<LastName>Hoy</LastName>
<ForeName>Jennifer</ForeName>
<Initials>J</Initials>
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<Affiliation>Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Florence</LastName>
<ForeName>Eric</ForeName>
<Initials>E</Initials>
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<Affiliation>Institute of Tropical Medicine, Antwerp, Belgium.</Affiliation>
</AffiliationInfo>
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<Affiliation>Charles University Hospital Plzen, Czech Republic.</Affiliation>
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</AffiliationInfo>
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<Affiliation>Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.</Affiliation>
</AffiliationInfo>
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<Affiliation>University Medical Centre Ljubljana, Clinic of Infectious Diseases Ljubljana, Medical Faculty, University of Ljubljana, Slovenia.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Gargalianos-Kakolyris</LastName>
<ForeName>Panagiotis</ForeName>
<Initials>P</Initials>
<AffiliationInfo>
<Affiliation>The General Hospital of Athens "G. Gennimatas" First Department Of Medicine - Infectious Diseases Unit, Athens, Greece.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Schmid</LastName>
<ForeName>Patrick</ForeName>
<Initials>P</Initials>
<AffiliationInfo>
<Affiliation>Division of Infectious Diseases, Cantonal Hospital St. Gallen, Switzerland.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Orkin</LastName>
<ForeName>Chloe</ForeName>
<Initials>C</Initials>
<AffiliationInfo>
<Affiliation>Barts and The Royal London Hospital NHS Trust, London, United Kingdom.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Pedersen</LastName>
<ForeName>Court</ForeName>
<Initials>C</Initials>
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<Affiliation>Odense Universitetshospital, Forskningsenheden, Denmark.</Affiliation>
</AffiliationInfo>
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<LastName>Leen</LastName>
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</AffiliationInfo>
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<LastName>Pradier</LastName>
<ForeName>Christian</ForeName>
<Initials>C</Initials>
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<Affiliation>CHU Nice Hopital de l' Archet 1, Nice, France.</Affiliation>
</AffiliationInfo>
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<Affiliation>St. James' Hospital, Dublin, Ireland.</Affiliation>
</AffiliationInfo>
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<LastName>Ridolfo</LastName>
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<Affiliation>Ospedale L. Sacco, Milan, Italy.</Affiliation>
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