Fractures after antiretroviral initiation
Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates. We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants fro...
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| Veröffentlicht in: | AIDS (London) 2012-11, Vol.26 (17), p.2175-2184 |
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| creator | YIN, Michael T KENDALL, Michelle A XINGYE WU TASSIOPOULOS, Katherine HOCHBERG, Marc HUANG, Jeannie S GLESBY, Marshall J BOLIVAR, Hector MCCOMSEY, Grace A |
| description | Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates.
We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence.
Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals.
Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals. |
| doi_str_mv | 10.1097/QAD.0b013e328359a8ca |
| format | Article |
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We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence.
Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals.
Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.</description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0b013e328359a8ca</identifier><identifier>PMID: 22951635</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Accidental Falls - statistics & numerical data ; Acquired Immunodeficiency Syndrome - complications ; Acquired Immunodeficiency Syndrome - drug therapy ; Acquired Immunodeficiency Syndrome - physiopathology ; Adult ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - adverse effects ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiviral agents ; Biological and medical sciences ; Body Mass Index ; Bone Density - drug effects ; CD4 Lymphocyte Count ; Female ; Follow-Up Studies ; Fractures, Bone - chemically induced ; Fractures, Bone - etiology ; Fractures, Bone - physiopathology ; Glucocorticoids - adverse effects ; HIV Seropositivity - complications ; HIV Seropositivity - drug therapy ; HIV Seropositivity - physiopathology ; Human viral diseases ; Humans ; Incidence ; Infectious diseases ; Injuries of the limb. Injuries of the spine ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Proportional Hazards Models ; Retrospective Studies ; Smoking - adverse effects ; Surveys and Questionnaires ; Time Factors ; Traumas. Diseases due to physical agents ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>AIDS (London), 2012-11, Vol.26 (17), p.2175-2184</ispartof><rights>2015 INIST-CNRS</rights><rights>2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-180754cf3a6793b9ca5c8dc82ceb97f09e62ee0cb70c213049edd536167475203</citedby><cites>FETCH-LOGICAL-c471t-180754cf3a6793b9ca5c8dc82ceb97f09e62ee0cb70c213049edd536167475203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26625266$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22951635$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>YIN, Michael T</creatorcontrib><creatorcontrib>KENDALL, Michelle A</creatorcontrib><creatorcontrib>XINGYE WU</creatorcontrib><creatorcontrib>TASSIOPOULOS, Katherine</creatorcontrib><creatorcontrib>HOCHBERG, Marc</creatorcontrib><creatorcontrib>HUANG, Jeannie S</creatorcontrib><creatorcontrib>GLESBY, Marshall J</creatorcontrib><creatorcontrib>BOLIVAR, Hector</creatorcontrib><creatorcontrib>MCCOMSEY, Grace A</creatorcontrib><title>Fractures after antiretroviral initiation</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description>Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates.
We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence.
Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals.
Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.</description><subject>Accidental Falls - statistics & numerical data</subject><subject>Acquired Immunodeficiency Syndrome - complications</subject><subject>Acquired Immunodeficiency Syndrome - drug therapy</subject><subject>Acquired Immunodeficiency Syndrome - physiopathology</subject><subject>Adult</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Anti-HIV Agents - adverse effects</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiviral agents</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Bone Density - drug effects</subject><subject>CD4 Lymphocyte Count</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fractures, Bone - chemically induced</subject><subject>Fractures, Bone - etiology</subject><subject>Fractures, Bone - physiopathology</subject><subject>Glucocorticoids - adverse effects</subject><subject>HIV Seropositivity - complications</subject><subject>HIV Seropositivity - drug therapy</subject><subject>HIV Seropositivity - physiopathology</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infectious diseases</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Smoking - adverse effects</subject><subject>Surveys and Questionnaires</subject><subject>Time Factors</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1LAzEQhoMotlb_gUgvgh5WJ8nm6yKUalUoiKDnkM1mNbLdrUm24L93pbV-nOYwz7zz8iB0jOECgxKXj5PrCygAU0eJpEwZac0OGuJc0IwxgXfREAhXmaICBuggxjcAYCDlPhoQohjmlA3R-SwYm7rg4thUyYWxaZIPLoV25YOpx77xyZvk2-YQ7VWmju5oM0foeXbzNL3L5g-399PJPLO5wCnDEgTLbUUNF4oWyhpmZWklsa5QogLlOHEObCHAEkwhV64sGeWYi1wwAnSErta5y65YuNK6JvVF9DL4hQkfujVe_900_lW_tCtNOSOc4j7gbBMQ2vfOxaQXPlpX16ZxbRc1JlRizASVPZqvURvaGIOrtm8w6C_Lures_1vuz05-V9wefWvtgdMNYKI1dRVMY3384TgnfVdOPwFU24bp</recordid><startdate>20121113</startdate><enddate>20121113</enddate><creator>YIN, Michael T</creator><creator>KENDALL, Michelle A</creator><creator>XINGYE WU</creator><creator>TASSIOPOULOS, Katherine</creator><creator>HOCHBERG, Marc</creator><creator>HUANG, Jeannie S</creator><creator>GLESBY, Marshall J</creator><creator>BOLIVAR, Hector</creator><creator>MCCOMSEY, Grace A</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U1</scope><scope>7U2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20121113</creationdate><title>Fractures after antiretroviral initiation</title><author>YIN, Michael T ; KENDALL, Michelle A ; XINGYE WU ; TASSIOPOULOS, Katherine ; HOCHBERG, Marc ; HUANG, Jeannie S ; GLESBY, Marshall J ; BOLIVAR, Hector ; MCCOMSEY, Grace A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-180754cf3a6793b9ca5c8dc82ceb97f09e62ee0cb70c213049edd536167475203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Accidental Falls - statistics & numerical data</topic><topic>Acquired Immunodeficiency Syndrome - complications</topic><topic>Acquired Immunodeficiency Syndrome - drug therapy</topic><topic>Acquired Immunodeficiency Syndrome - physiopathology</topic><topic>Adult</topic><topic>Anti-HIV Agents - administration & dosage</topic><topic>Anti-HIV Agents - adverse effects</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiviral agents</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Bone Density - drug effects</topic><topic>CD4 Lymphocyte Count</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fractures, Bone - chemically induced</topic><topic>Fractures, Bone - etiology</topic><topic>Fractures, Bone - physiopathology</topic><topic>Glucocorticoids - adverse effects</topic><topic>HIV Seropositivity - complications</topic><topic>HIV Seropositivity - drug therapy</topic><topic>HIV Seropositivity - physiopathology</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Smoking - adverse effects</topic><topic>Surveys and Questionnaires</topic><topic>Time Factors</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>YIN, Michael T</creatorcontrib><creatorcontrib>KENDALL, Michelle A</creatorcontrib><creatorcontrib>XINGYE WU</creatorcontrib><creatorcontrib>TASSIOPOULOS, Katherine</creatorcontrib><creatorcontrib>HOCHBERG, Marc</creatorcontrib><creatorcontrib>HUANG, Jeannie S</creatorcontrib><creatorcontrib>GLESBY, Marshall J</creatorcontrib><creatorcontrib>BOLIVAR, Hector</creatorcontrib><creatorcontrib>MCCOMSEY, Grace A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>YIN, Michael T</au><au>KENDALL, Michelle A</au><au>XINGYE WU</au><au>TASSIOPOULOS, Katherine</au><au>HOCHBERG, Marc</au><au>HUANG, Jeannie S</au><au>GLESBY, Marshall J</au><au>BOLIVAR, Hector</au><au>MCCOMSEY, Grace A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fractures after antiretroviral initiation</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2012-11-13</date><risdate>2012</risdate><volume>26</volume><issue>17</issue><spage>2175</spage><epage>2184</epage><pages>2175-2184</pages><issn>0269-9370</issn><eissn>1473-5571</eissn><abstract>Bone mineral density declines by 2-6% within 1-2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates.
We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence.
Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/μl. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals.
Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>22951635</pmid><doi>10.1097/QAD.0b013e328359a8ca</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | AIDS (London), 2012-11, Vol.26 (17), p.2175-2184 |
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| subjects | Accidental Falls - statistics & numerical data Acquired Immunodeficiency Syndrome - complications Acquired Immunodeficiency Syndrome - drug therapy Acquired Immunodeficiency Syndrome - physiopathology Adult Anti-HIV Agents - administration & dosage Anti-HIV Agents - adverse effects Antibiotics. Antiinfectious agents. Antiparasitic agents Antiviral agents Biological and medical sciences Body Mass Index Bone Density - drug effects CD4 Lymphocyte Count Female Follow-Up Studies Fractures, Bone - chemically induced Fractures, Bone - etiology Fractures, Bone - physiopathology Glucocorticoids - adverse effects HIV Seropositivity - complications HIV Seropositivity - drug therapy HIV Seropositivity - physiopathology Human viral diseases Humans Incidence Infectious diseases Injuries of the limb. Injuries of the spine Male Medical sciences Middle Aged Pharmacology. Drug treatments Proportional Hazards Models Retrospective Studies Smoking - adverse effects Surveys and Questionnaires Time Factors Traumas. Diseases due to physical agents Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| title | Fractures after antiretroviral initiation |
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