Fracture Risk and Association With TDF Use Among People With HIV in Large Integrated Health Systems.

Autor:	Hechter RC; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA., Zhou H; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA., Leyden WA; Division of Research, Kaiser Permanente Northern California, Oakland, CA., Yuan Q; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA., Pak KJ; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA., Lam JO; Division of Research, Kaiser Permanente Northern California, Oakland, CA., Alexeeff S; Division of Research, Kaiser Permanente Northern California, Oakland, CA., Lea A; Division of Research, Kaiser Permanente Northern California, Oakland, CA., Hu H; Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD., Marcus JL; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; and., Rivera AS; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA., Adams AL; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA., Horberg MA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.; Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD., Towner WJ; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA., Lo JC; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.; Division of Research, Kaiser Permanente Northern California, Oakland, CA., Silverberg MJ; Division of Research, Kaiser Permanente Northern California, Oakland, CA.; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; and.; Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2023 Dec 01; Vol. 94 (4), pp. 341-348.
DOI:	10.1097/QAI.0000000000003274
Abstrakt:	Background: Greater decline in bone health among people with HIV (PWH) has been documented but fracture risk and the impact of specific antiretroviral therapy (ART) regimens remain unclear. Setting: Retrospective analyses of electronic health record data from 3 US integrated health care systems. Methods: Fracture incidence was compared between PWH aged 40 years or older without prior fracture and demographically matched people without HIV (PWoH), stratified by age, sex, and race/ethnicity. Multivariable Cox proportional hazards models were used to estimate fracture risk associated with HIV infection. The association of tenofovir disoproxil fumarate (TDF) use and fracture risk was evaluated in a subset of PWH initiating ART. Results: Incidence of fracture was higher in PWH [13.6/1000 person-years, 95% confidence interval (CI): 13.0 to 14.3, n = 24,308] compared with PWoH (9.5, 95% CI: 9.4 to 9.7, n = 247,313). Compared with PWoH, the adjusted hazard ratio (aHR) for fracture among PWH was 1.24 (95% CI: 1.18 to 1.31). The association between HIV infection and fracture risk increased with age, with the lowest aHR (1.17, 95% CI: 1.10 to 1.25) among those aged 40-49 years and the highest aHR (1.89, 95% CI: 1.30 to 2.76) among those aged 70 years or older. Among PWH initiating ART (n = 6504), TDF was not associated with significant increase in fracture risk compared with non-TDF regimens (aHR: 1.18, 95% CI: 0.89 to 1.58). Conclusions: Among people aged 40 years or older, HIV infection is associated with increased risk of fractures. Bone health screening from the age of 40 years may be beneficial for PWH. Large cohort studies with longer follow-up are needed to evaluate TDF effect and the potential benefit of early screening. Competing Interests: M.J.S., W.J.T., and M.A.H. received research funding for this study from Gilead Sciences, Inc. R.C.H. received research funding from Gilead Sciences, Inc. for an unrelated study. H.Z. received research funding from Merck for an unrelated study. W.J.T. received research funding from Pfizer, ViiV, Merck, Janssen, Moderna, and GlaxoSmithKline for unrelated studies. The remaining authors have no conflicts of interest to disclose. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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