- HIV-infected patients taking tenofovir disoproxil fumarate (TDF) or protease inhibitors (PIs) do not have increased fracture risk.
Why this matters
- Patients with HIV have reduced bone mineral density and increased fracture risk, but the effect of antiretroviral therapy (ART) on fracture risk has been controversial.
- These authors say the findings have “important implications for the debate concerning tenofovir alafenamide versus generic TDF.”
- With adjustments for age, BMI, etc., TDF showed no link to fracture risk: OR for cumulative exposure, 1.04 (95% CI, 0.86-1.27).
- PIs also showed no association: OR, 1.02 (0.92-1.12).
- Nucleoside reverse transcriptase inhibitors also were not linked to risk.
- Outcome remained unchanged, regardless of exposure model, inclusion of chronic kidney disease.
- Associations of efavirenz, atazanavir with reduced and increased risk, respectively, in some models did not hold up in sensitivity analyses.
- 254 osteoporotic fracture cases matched to 376 controls.
- 49% had TDF exposure; 82% had PI exposure.
- All were enrolled while ART-naive.
- Funding: France REcherche Nord & Sud Sida-hiv Hépatites; Agence Nationale de Sécurité du médicament et des produits de santé.
- Cases had lower BMI, more alcohol consumption.
- More than a third lacked information on family history of hip fracture.