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Stable or increasing bone mineral density in HIV-infected patients treated with nelfinavir or indinavir

Nolan, D., Upton, R., McKinnon, E., John, M., James, I., Adler, B., Roff, G., Vasikaran, S. and Mallal, S. (2001) Stable or increasing bone mineral density in HIV-infected patients treated with nelfinavir or indinavir. AIDS, 15 (10). pp. 1275-1280.

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Background and objectives: To determine the factors contributing to changes in bone mineral density (BMD) over time in HIV-infected patients receiving highly active antiretroviral therapy (HAART).

Methods: Analyses of lumbar spine BMD in 183 male Caucasian participants in the Western Australian HIV Cohort study, comprising a longitudinal analysis of data from 54 patients on stable HAART regimens, and a cross-sectional analysis comparing data from 131 protease inhibitor (PI)-treated patients and 52 PI-naive (including 28 antiretroviral treatment-naive) patients.

Results: Average lumbar spine BMD remained stable or increased over the time frame considered. Although there was no evidence of a change of average BMD over time in patients receiving nelfinavir (P = 0.92), there was evidence of increasing bone density in the indinavir group (average increase, 0.31 z-score per year;P < 0.001). Lower initial z-scores in the longitudinal analysis were significantly associated with lower pre-HAART BMI (P = 0.003), consistent with results of the cross-sectional analysis in which lowest BMI prior to initial dual X-ray absorptiometry scan was associated with decreased BMD (P = 0.02, overall group). Although PI therapy was also associated with decreased BMD in a univariate analysis of the cross-sectional data (P = 0.04), this effect was abrogated in a multiple linear regression analysis (P = 0.11) with lowest BMI remaining significant (P = 0.04).

Conclusions: We found no evidence, overall, of accelerated bone loss in patients treated with nelfinavir- or indinavir-containing HAART regimens, and propose that indinavir therapy may be associated with an increase in bone mineral density over time. Pre-HAART BMI was an independent and powerful determinant of an individual's initial z-score in the longitudinal analysis, and adjustment for this effect in a cross-sectional analysis abrogated the association between PI therapy and decreased lumbar spine z-score.

Item Type: Journal Article
Murdoch Affiliation(s): Centre for Clinical Immunology and Biomedical Statistics
Publisher: Lippincott Williams & Wilkins Ltd.
Copyright: © 2001 Lippincott Williams & Wilkins, Inc.
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