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Efavirenz is associated with higher bone mass in South African children with HIV.
- Source :
-
AIDS (London, England) [AIDS] 2016 Oct 23; Vol. 30 (16), pp. 2459-2467. - Publication Year :
- 2016
-
Abstract
- Background: We investigate if switching from a ritonavir-boosted lopinavir (LPV/r)-based to an efavirenz-based antiretroviral therapy (ART) regimen is associated with beneficial bone development.<br />Methods: The CHANGES Bone Study follows HIV-infected children who participated in a noninferiority randomized trial in Johannesburg, South Africa evaluating the safety and efficacy of preemptive switching to efavirenz (n = 106) compared with remaining on LPV/r (n = 113). HIV-uninfected children were also recruited. Whole-body and lumbar spine bone mineral content (BMC) were assessed by dual-energy X-ray absorptiometry at a cross-sectional visit. BMC Z-scores adjusted for sex, age, and height were generated. Physical activity and dietary intake were assessed. CD4 percentage and viral load were measured. We compared bone indices of HIV-infected with HIV-uninfected children and LPV/r with efavirenz by intent-to-treat.<br />Results: The 219 HIV-infected (52% boys) and 219 HIV-uninfected (55% boys) children were 6.4 and 7.0 years of age, respectively. Mean ART duration for HIV-infected children was 5.7 years. Whole-body BMC Z-score was 0.17 lower for HIV-infected children compared with HIV-uninfected children after adjustment for physical activity, dietary vitamin D and calcium (P = 0.03). Whole-body BMC Z-score was 0.55 higher for HIV-infected children switched to efavirenz compared with those remaining on LPV/r after adjustment for physical activity, dietary vitamin D and calcium, CD4 percentage, and viral load (P < 0.0001).<br />Conclusion: South African HIV-infected children receiving ART have lower bone mass compared with HIV-uninfected controls. Accrued bone mass is positively associated with switching to efavirenz-based ART compared with remaining on LPV/r, providing additional rationale for limiting LPV/r exposure once viral suppression has been achieved.
- Subjects :
- Absorptiometry, Photon
Alkynes
Anti-Retroviral Agents adverse effects
Benzoxazines adverse effects
CD4 Lymphocyte Count
Child
Cross-Sectional Studies
Cyclopropanes
Female
Humans
Lopinavir adverse effects
Lopinavir therapeutic use
Male
Ritonavir adverse effects
Ritonavir therapeutic use
South Africa
Treatment Outcome
Viral Load
Anti-Retroviral Agents therapeutic use
Benzoxazines therapeutic use
Bone Development drug effects
Bone and Bones anatomy & histology
HIV Infections drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5571
- Volume :
- 30
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- AIDS (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 27427876
- Full Text :
- https://doi.org/10.1097/QAD.0000000000001204