Antiretroviral therapy and bone mineral measurements in HIV-infected youths

• Published in: Bone (New York, N.Y.) Vol. 46; no. 6; pp. 1633 - 1638
• Main Authors: Zuccotti, Gianvincenzo, Viganò, Alessandra, Gabiano, Clara, Giacomet, Vania, Mignone, Federica, Stucchi, Sara, Manfredini, Valeria, Marinacci, Francesca, Mora, Stefano
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier 01.06.2010
• Subjects: Adolescent; Alkaline Phosphatase - blood; Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Benzoxazines - pharmacology; Benzoxazines - therapeutic use; Biological and medical sciences; Bone Density - drug effects; Bone Density - physiology; Child; Child, Preschool; Cross-Sectional Studies; Female; Fundamental and applied biological sciences. Psychology; HIV Infections - blood; HIV Infections - drug therapy; HIV Infections - metabolism; HIV Infections - urine; HIV Protease Inhibitors - pharmacology; HIV Protease Inhibitors - therapeutic use; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Orthopedics; Pharmacology. Drug treatments; Reverse Transcriptase Inhibitors - pharmacology; Reverse Transcriptase Inhibitors - therapeutic use; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; Bone mineral content; Dual-energy X-ray absorptiometry; Children; HIV infection; Antiretroviral treatment; Human; Immunopathology; Antiretroviral agent; AIDS; Immune deficiency; Infection; Chemotherapy; X ray absorption spectrometry; Treatment; Viral disease; Morphology; Dual energy absorptiometry; Antiviral; Bone mineral density; Bone; Child
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2010.02.029

Abstract Reduced bone mass measurements are often found in HIV-infected youths. Both in vitro and human studies demonstrated a role of antiretroviral treatment in determining bone mass alteration. Nevertheless, the data regarding the responsibility of different antiretroviral drugs on bone health in children and adolescents are highly controversial. The purpose of the current study was to relate antiretroviral treatment to bone mass measurements in a large cohort of HIV-infected children and adolescents. Bone mineral content (BMC) was measured in 86 HIV-infected youths (aged 4.8–22.1 years), and in 194 healthy controls (aged 4.9–21.9 years). Fifteen patients were naive to antiretroviral treatment, 11 were receiving a dual nucleoside reverse transcriptase inhibitor (NRTIs) combination, 32 a protease inhibitor (PI)-based antiretroviral treatment, and 28 a non-nucleoside reverse transcriptase inhibitor (NNRTIs)-based regimen. Comparisons between healthy and HIV-infected children and adolescents have been performed by multiple regression analyses to correct for differences in age, sex, and anthropometric measurements. Patients receiving a PI-based treatment had lumbar spine and whole body BMC values significantly lower than healthy children ( P < 0.05). BMC measurements of patients on other therapeutic regimens or naive to antiretroviral treatment did not differ significantly from those of healthy children. Among patients receiving a PI-based regimen, those receiving full dose Ritonavir had significantly lower lumbar spine BMC values compared to other patients. Lumbar spine and whole body BMC measurements of patients receiving a Stavudine-containing regimen were lower compared to healthy controls, naive patients, and patients on other antiretroviral regimens. Multivariate analyses showed that patients receiving both Stavudine and full dose Ritonavir had significantly lower BMC values both at the lumbar spine ( P = 0.0033), and in the whole skeleton ( P = 0.05). In conclusion, antiretroviral treatment may have a detrimental effect on bone health of HIV-infected youths: the use of Ritonavir full dose alone or in combination with Stavudine is associated to lower bone mass measurements. The use of antiretroviral regimens including these drugs should thus be monitored closely in HIV-infected youths.