ART and fracture risk: no association with TDF or PI exposure

  • Costagliola D & al.
  • J Acquir Immune Defic Syndr
  • 29 Oct 2018

  • from Emily Willingham, PhD
  • Medical News
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Takeaway

  • 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.”

Key results

  • 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.

Study design

  • 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.

Limitations

  • Cases had lower BMI, more alcohol consumption.
  • More than a third lacked information on family history of hip fracture.