Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort
| Autor: | Eric Florence, Jens D Lundgren, P. Gargalianos-Kakolyris, Court Pedersen, Fernando Maltez, V. Uzdaviniene, Thérèse Staub, for EuroSIDA, Jennifer F Hoy, Leo Flamholc, G. Kyselyova, Hans Jürgen Stellbrink, Rainer Weber, J Tomazic, Chloe Orkin, Anna Lisa Ridolfo, Fiona Mulcahy, Christian Pradier, Patrick Schmid, Dalibor Sedláček, Álvaro H. Borges, Amanda Mocroft, Clifford Leen |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
0301 basic medicine Bone density Femoral Fractures / etiology HCC INF Tenofovir / therapeutic use Avascular necrosis HIV Infections / complications Cohort Studies HIV Infections / epidemiology 0302 clinical medicine Risk Factors Medicine 030212 general & internal medicine Osteonecrosis / virology HIV Infections / virology Fractures Bone / epidemiology Data Collection Incidence (epidemiology) Middle Aged Infectious Diseases Cohort Coinfection Regression Analysis Female Europe / epidemiology Anti-HIV Agents / adverse effects Fractures Bone / virology Cohort study Adult Anti-HIV Agents / therapeutic use Microbiology (medical) medicine.medical_specialty Tenofovir / adverse effects Fractures Bone / etiology Bone Density / drug effects Femoral Fractures / epidemiology Femoral Fractures / virology Fractures Bone / ethnology 03 medical and health sciences Acquired immunodeficiency syndrome (AIDS) Osteonecrosis / etiology Internal medicine Journal Article Humans Risk factor Osteonecrosis / epidemiology Coinfection / epidemiology business.industry medicine.disease 030112 virology HIV Infections / drug therapy CD4 Lymphocyte Count Surgery business Anti-HIV Agents / administration & dosage |
| Zdroj: | Borges, Á H, Hoy, J F, Florence, E, Sedlacek, D, Stellbrink, H-J, Uzdaviniene, V, Tomazic, J, Gargalianos-Kakolyris, P, Schmid, P, Orkin, C, Pedersen, C, Leen, C, Pradier, C, Mulcahy, F, Ridolfo, A L, Staub, T, Maltez, F, Weber, R, Flamholc, L, Kyselyova, G, Lundgren, J D, Mocroft, A & for EuroSIDA 2017, ' Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort ', Clinical Infectious Diseases, vol. 64, no. 10, pp. 1413-1421 . https://doi.org/10.1093/cid/cix167 Repositório Científico de Acesso Aberto de Portugal Repositório Científico de Acesso Aberto de Portugal (RCAAP) instacron:RCAAP |
| DOI: | 10.1093/cid/cix167 |
| Popis: | Background: Antiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes. Methods: EuroSIDA participants were followed to assess fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed. Results: During 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70.4% virologically suppressed), there were 619 fractures (incidence/1000 PYFU 7.2; 95% CI 6.6-7.7) and 89 osteonecrosis (1.0; 0.8-1.3). Older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV coinfection, prior osteonecrosis, prior fracture, cardiovascular disease, and recent non-AIDS cancer (last 12 months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y exposure; 0.94-1.25). No other ARV was associated with fractures (all P > .1). Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture, and prior AIDS. After mutual adjustment, no ARV was associated with osteonecrosis. Conclusions: In human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures. info:eu-repo/semantics/publishedVersion |
| Databáze: | OpenAIRE |
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