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document
Loss of bone mineral density after antiretroviral therapy initiation , independent of antiretroviral regimen . BACKGROUND Decreased bone mineral density ( BMD ) has been described in HIV-infected patients initiating antiretroviral therapy ( ART ) , but the contributions of ART and immunologic and/or virologic factors remain unclear . METHODS We compared total BMD changes over 96 weeks in 106 ART-naive HIV-infected subjects who were randomized to receive efavirenz ( EFV ) + zidovudine/lamivudine ( n = 32 ) or lopinavir/ritonavir ( LPV/r ) + zidovudine/lamivudine induction ( n = 74 ) for 24-48 weeks followed by LPV/r monotherapy . We also sought to identify factors associated with BMD loss , including markers of systemic inflammation [ soluble tumor necrosis factor-alpha receptors ( sTNFR I and II ) ] . RESULTS After 96 weeks , the mean percent change from baseline in total BMD was -2.5 % ( LPV/r ) and -2.3 % ( EFV ) ( P < 0.01 for within-group changes in either arm ; P = 0.86 for between-group differences ) . No alteration in the rate of BMD change was observed upon simplification to LPV/r monotherapy . Although soluble tumor necrosis factor-alpha receptor II concentrations at baseline and 24 weeks were at least marginally associated with subsequent changes in BMD ( P = 0.06 and P = 0.028 , respectively ) , these associations were no longer significant after adjustment for CD4 T cell count . Subjects with lower baseline CD4 T cell count , non-black race , and higher baseline glucose demonstrated a higher risk for > 5 % decrease in BMD . CONCLUSIONS Similar decreases in BMD over 96 weeks occurred in ART-naive subjects receiving either EFV-based regimen or LPV/r-based regimen , which was not altered by simplification to LPV/r monotherapy and was unrelated to markers of tumor necrosis factor-alpha activity .
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Intervention_Psychological
antiretroviral therapy initiation
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Intervention_Pharmacological
efavirenz ( EFV ) + zidovudine/lamivudine ( n = 32 ) or lopinavir/ritonavir ( LPV/r ) + zidovudine/lamivudine induction
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Intervention_Psychological
LPV/r monotherapy .
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Outcome_Physical
bone mineral density
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Outcome_Physical
bone mineral density ( BMD )
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Outcome_Physical
BMD
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Outcome_Physical
percent change from baseline in total BMD
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Outcome_Physical
rate of BMD change
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Outcome_Physical
BMD
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Outcome_Physical
BMD
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Outcome_Physical
BMD
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Participant_Condition
HIV-infected patients initiating antiretroviral therapy ( ART )
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Participant_Sample-size
106
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Participant_Condition
ART-naive HIV-infected subjects
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Participant_Sample-size
32
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Participant_Sample-size
74
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Participant_Condition
Subjects with lower baseline CD4 T cell count
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Participant_Condition
ART-naive