Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study.

Bayard, Cornelia; Ledergerber, Bruno; Flepp, Markus; Lecompte, Thanh; Moulin, Estelle; Hoffmann, Matthias; Weber, Rainer; Stähelin, Cornelia Johanna; Di Benedetto, Caroline; Fux, Christoph A; Tarr, Philip E; Hasse, Barbara (2017). Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study. Open Forum Infectious Diseases, 4(4), ofx177. Oxford University Press 10.1093/ofid/ofx177

[img]
Preview
Text
ofx177.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (236kB) | Preview

BACKGROUND

HIV-infected individuals have an increased risk of avascular bone necrosis (AVN). Antiretroviral therapy (ART) and particularly protease inhibitors (PI) have been implicated as a risk factor. We aimed to study the associations of ART with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS).

METHODS

We used incidence density sampling to perform a case control study within the Swiss HIV Cohort Study (SHCS) comparing prospectively collected AVN cases and controls by conditional logistic regression analysis. To evaluate the effect of ART, multivariable models were adjusted for HIV transmission risk group, age, alcohol consumption, use of corticosteroids, CD4 nadir, maximum viral load, and pancreatitis.

RESULTS

We compared 74 AVN cases and 145 controls. Associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-10), alcohol consumption (OR, 2.7; 95% CI, 1.3-5.7), and hyperlipidemia (OR, 3.6; 95% CI, 1.4-9.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4; 95% CI, 1.4-14) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN.

CONCLUSIONS

In the HIV-infected population, a combination of risk factors such as heterosexual HIV acquisition, moderate to severe alcohol intake, and hyperlipidemia seem to contribute to AVN. ART does not seem to be a relevant risk factor for AVN. The association of prolonged TDF exposure with AVN needs to be confirmed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Stähelin, Cornelia Johanna

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2328-8957

Publisher:

Oxford University Press

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

22 Nov 2017 09:49

Last Modified:

23 Oct 2019 06:16

Publisher DOI:

10.1093/ofid/ofx177

PubMed ID:

29026869

Uncontrolled Keywords:

HIV antiretroviral therapy avascular bone necrosis tenofovir

BORIS DOI:

10.7892/boris.106490

URI:

https://boris.unibe.ch/id/eprint/106490

Actions (login required)

Edit item Edit item
Provide Feedback