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Bone Mineral Density and Vitamin D Levels in HIV Treatment-Naïve African American Individuals Randomized to Receive HIV Drug Regimens.
South Med J 2016; 109(11):712-717SM

Abstract

OBJECTIVES

Treatment of human immunodeficiency virus (HIV)-infected patients with tenofovir disoproxil fumarate is associated with a decrease in bone mineral density (BMD). Treatment with efavirenz is associated with vitamin D deficiency. We compared the effects of efavirenz, emtricitabine, and tenofovir disoproxil fumarate (EFV/FTC/TDF) with the effects of raltegravir, darunavir, and ritonavir (RAL/DRV/r) on BMD and 25-hydroxyvitamin D (25[OH]D) levels in HIV-infected, antiretroviral treatment-naïve African American subjects.

METHODS

This was a pilot study at a single HIV clinic. Forty HIV treatment-naïve African American subjects were screened, 35 of whom were randomized to receive either EFV/FTC/TDF or RAL/DRV/r. All of the subjects received supplemental vitamin D3 and calcium. CD4 counts, HIV RNA, parathyroid hormone, osteocalcin, N-telopeptide, and 25(OH)D levels were obtained at baseline and at 8, 24, 36, and 48 weeks. Dual-energy x-ray absorptiometry of the spine and hip was performed at baseline and at week 48.

RESULTS

Of the 35 subjects enrolled, 10 patients receiving each regimen completed the study. Median baseline 25(OH)D levels were decreased and similar in both groups. All of the patients had plasma HIV RNA <50 copies per milliliter by week 24. By week 48, there was a sustained increase in 25(OH)D in the RAL/DRV/r group (P = 0.0004) but not in the EFV/FTC/TDF group (P = 0.78). There were reductions in BMD of the mean total hip (P = 0.002) and the mean femoral neck (P = 0.004) in the EFV/FTC/TDF group but not in the RAL/DRV/r group.

CONCLUSIONS

Treatment of African American patients with HIV using EFV/FTC/TDF is associated with a reduction in BMD of the hip and sustained reductions of 25(OH)D not seen in the group that received RAL/DRV/r. This phenomenon may have long-term consequences on bone integrity in this population.

Authors+Show Affiliations

From the Department of Medicine, Division of Infectious Diseases, the Department of Microbiology, and the Department of Medicine, Division of Endocrinology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.From the Department of Medicine, Division of Infectious Diseases, the Department of Microbiology, and the Department of Medicine, Division of Endocrinology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.From the Department of Medicine, Division of Infectious Diseases, the Department of Microbiology, and the Department of Medicine, Division of Endocrinology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.From the Department of Medicine, Division of Infectious Diseases, the Department of Microbiology, and the Department of Medicine, Division of Endocrinology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.From the Department of Medicine, Division of Infectious Diseases, the Department of Microbiology, and the Department of Medicine, Division of Endocrinology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27812717

Citation

Cook, Paul P., et al. "Bone Mineral Density and Vitamin D Levels in HIV Treatment-Naïve African American Individuals Randomized to Receive HIV Drug Regimens." Southern Medical Journal, vol. 109, no. 11, 2016, pp. 712-717.
Cook PP, Stang AT, Walker LR, et al. Bone Mineral Density and Vitamin D Levels in HIV Treatment-Naïve African American Individuals Randomized to Receive HIV Drug Regimens. South Med J. 2016;109(11):712-717.
Cook, P. P., Stang, A. T., Walker, L. R., Akula, S. M., & Cook, F. J. (2016). Bone Mineral Density and Vitamin D Levels in HIV Treatment-Naïve African American Individuals Randomized to Receive HIV Drug Regimens. Southern Medical Journal, 109(11), pp. 712-717.
Cook PP, et al. Bone Mineral Density and Vitamin D Levels in HIV Treatment-Naïve African American Individuals Randomized to Receive HIV Drug Regimens. South Med J. 2016;109(11):712-717. PubMed PMID: 27812717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bone Mineral Density and Vitamin D Levels in HIV Treatment-Naïve African American Individuals Randomized to Receive HIV Drug Regimens. AU - Cook,Paul P, AU - Stang,Alexandra Te, AU - Walker,Lia R, AU - Akula,Shaw M, AU - Cook,Fiona J, PY - 2016/11/5/pubmed PY - 2017/5/4/medline PY - 2016/11/5/entrez SP - 712 EP - 717 JF - Southern medical journal JO - South. Med. J. VL - 109 IS - 11 N2 - OBJECTIVES: Treatment of human immunodeficiency virus (HIV)-infected patients with tenofovir disoproxil fumarate is associated with a decrease in bone mineral density (BMD). Treatment with efavirenz is associated with vitamin D deficiency. We compared the effects of efavirenz, emtricitabine, and tenofovir disoproxil fumarate (EFV/FTC/TDF) with the effects of raltegravir, darunavir, and ritonavir (RAL/DRV/r) on BMD and 25-hydroxyvitamin D (25[OH]D) levels in HIV-infected, antiretroviral treatment-naïve African American subjects. METHODS: This was a pilot study at a single HIV clinic. Forty HIV treatment-naïve African American subjects were screened, 35 of whom were randomized to receive either EFV/FTC/TDF or RAL/DRV/r. All of the subjects received supplemental vitamin D3 and calcium. CD4 counts, HIV RNA, parathyroid hormone, osteocalcin, N-telopeptide, and 25(OH)D levels were obtained at baseline and at 8, 24, 36, and 48 weeks. Dual-energy x-ray absorptiometry of the spine and hip was performed at baseline and at week 48. RESULTS: Of the 35 subjects enrolled, 10 patients receiving each regimen completed the study. Median baseline 25(OH)D levels were decreased and similar in both groups. All of the patients had plasma HIV RNA <50 copies per milliliter by week 24. By week 48, there was a sustained increase in 25(OH)D in the RAL/DRV/r group (P = 0.0004) but not in the EFV/FTC/TDF group (P = 0.78). There were reductions in BMD of the mean total hip (P = 0.002) and the mean femoral neck (P = 0.004) in the EFV/FTC/TDF group but not in the RAL/DRV/r group. CONCLUSIONS: Treatment of African American patients with HIV using EFV/FTC/TDF is associated with a reduction in BMD of the hip and sustained reductions of 25(OH)D not seen in the group that received RAL/DRV/r. This phenomenon may have long-term consequences on bone integrity in this population. SN - 1541-8243 UR - https://www.unboundmedicine.com/medline/citation/27812717/Bone_Mineral_Density_and_Vitamin_D_Levels_in_HIV_Treatment_Naïve_African_American_Individuals_Randomized_to_Receive_HIV_Drug_Regimens_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=27812717.ui DB - PRIME DP - Unbound Medicine ER -