Evolution of bone mineral density in AIDS patients on treatment with zidovudine/lamivudine plus abacavir or lopinavir/ritonavir.
OBJECTIVE
The aim of the study was to determine the factors that may contribute to decreases in bone mineral density (BMD) in patients with AIDS.


METHODS
This was a prospective, non-randomized study. Dual X-ray absorptiometry (DXA) was used to determine the BMD of the lumbar spine, femoral neck and distal radius in treatment-naïve HIV-infected male patients with AIDS before and after 1 year of treatment with zidovudine (ZDV)/lamivudine (3TC) plus abacavir (ABC) or lopinavir/ritonavir (LPV/r).


RESULTS
Basal DXA was performed in 50 patients with CD4 counts <200 cells/microL and/or any AIDS-defining condition. Thirty-two patients completed 1 year with full adherence (17 on ABC and 15 on LPV/r) and a second DXA was then performed. At baseline, 19% had osteopenia at the lumbar spine and 19% at the femoral neck. Low body weight was related to low BMD. After 48 weeks, BMD loss was significant at the three locations. The percentage of BMD loss at the femoral neck tended to be greater in the lopinavir group (5.3 vs. 3.2%, P=0.058). The differences became significant at the lumbar spine (5.7 vs. 2.7%, P=0.044). In the multivariate analysis, the treatment with LPV/r remained associated with bone loss at the lumbar spine.


CONCLUSIONS
Osteopenia is frequent in treatment-naïve HIV-infected men with AIDS. Bone loss is higher with LPV/r-based regimens compared with triple nucleoside reverse transcriptase inhibitors.
Rivas
P
P
Service of Infectious Diseases, Hospital Carlos III, Madrid, Spain. pablorivasg@hotmail.com
Górgolas
M
M
García-Delgado
R
R
Díaz-Curiel
M
M
Goyenechea
A
A
Fernández-Guerrero
M L
ML
D015502:Absorptiometry, Photon; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D015519:Bone Density / Q000187:drug effects*; D016022:Case-Control Studies; D015224:Dideoxynucleosides / Q000008:administration & dosage; D005272:Femur Neck; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D061466:Lopinavir; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011744:Pyrimidinones / Q000008:administration & dosage; D019438:Ritonavir / Q000008:administration & dosage; D015215:Zidovudine / Q000008:administration & dosage; D000099227:Abacavir
D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D019259:Lamivudine; D061466:Lopinavir; D011744:Pyrimidinones; D019438:Ritonavir; D015215:Zidovudine; D000099227:Abacavir