title: Weight and lean body mass change with antiretroviral initiation and impact on bone mineral density.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: aUniversity of Colorado-Anschutz Medical Campus; Aurora, Colorado bHarvard School of Public Health, Boston cBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts dLos Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California eUniversity of Pennsylvania, Philadelphia, Pennsylvania fGilead Sciences, Foster City, California gViiV Healthcare, Research Triangle, North Carolina hSocial and Scientific Systems, Inc., Silver Spring, Maryland iCase Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Erlandson
authors.forename: Douglas
authors.initials: D
authors.lastname: Kitch
authors.forename: Camlin
authors.initials: C
authors.lastname: Tierney
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sax
authors.forename: Eric S
authors.initials: ES
authors.lastname: Daar
authors.forename: Pablo
authors.initials: P
authors.lastname: Tebas
authors.forename: Kathleen
authors.initials: K
authors.lastname: Melbourne
authors.forename: Belinda
authors.initials: B
authors.lastname: Ha
authors.forename: Nasreen C
authors.initials: NC
authors.lastname: Jahed
authors.forename: Grace A
authors.initials: GA
authors.lastname: McComsey
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001823:Body Composition / Q000187:drug effects*; D001835:Body Weight / Q000187:drug effects*; D015519:Bone Density / Q000187:drug effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed
chemical_list: D044966:Anti-Retroviral Agents