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Weight and lean body mass change with antiretroviral initiation and impact on bone mineral density . OBJECTIVE To compare the effect that initiating different antiretroviral therapy ( ART ) regimens has on weight , BMI , and lean body mass ( LBM ) and explore how changes in body composition are associated with bone mineral density ( BMD ) . METHODS A5224s was a sub-study of A5202 , a prospective trial of 1857 ART-naive participants randomized to blinded abacavir-lamivudine ( ABC/3TC ) or tenofovir DF-emtricitabine ( TDF/FTC ) with open-label efavirenz ( EFV ) or atazanavir-ritonavir ( ATV/r ) . All participants underwent dual-energy absorptiometry ( DXA ) and abdominal computed tomography for body composition . Analyses used two-sample t-tests and linear regression . RESULTS A5224s included 269 participants : 85 % men , 47 % white non-Hispanic , median age 38 years , HIV-1 RNA 4.6 log10 copies/ml , and CD4 cell count 233 cells/μl . Overall , significant gains occurred in weight , BMI , and LBM at 96 weeks post-randomization ( all P < 0.001 ) . Assignment to ATV/r ( vs. EFV ) resulted in significantly greater weight ( mean difference 3.35 kg ) and BMI gain ( 0.88 kg/m ; both P=0.02 ) , but not LBM ( 0.67 kg ; P=0.15 ) , whereas ABC/3TC and TDF/FTC were not significantly different ( P≥0.10 ) . In multivariable analysis , only lower baseline CD4 cell count and higher HIV-1 RNA were associated with greater increase in weight , BMI , or LBM . In multivariable analyses , increased LBM was associated with an increased hip BMD . CONCLUSION ABC/3TC vs. TDF/FTC did not differ in change in weight , BMI , or LBM ; ATV/r vs. EFV resulted in greater weight and BMI gain but not LBM . A positive association between increased LBM and increased hip BMD should be further investigated through prospective interventional studies to verify the impact of increased LBM on hip BMD .
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Intervention_Physical
antiretroviral initiation
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Intervention_Physical
antiretroviral therapy ( ART )
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Intervention_Pharmacological
abacavir-lamivudine ( ABC/3TC )
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Intervention_Pharmacological
tenofovir DF-emtricitabine ( TDF/FTC )
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Intervention_Pharmacological
atazanavir-ritonavir ( ATV/r )
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Intervention_Physical
dual-energy absorptiometry ( DXA )
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Intervention_Physical
abdominal computed tomography for body composition
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Intervention_Pharmacological
ATV/r
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Outcome_Physical
CD4 cell count
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Outcome_Physical
higher HIV-1 RNA
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Outcome_Physical
hip BMD
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Outcome_Physical
weight
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Participant_Condition
antiretroviral initiation