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Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial

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Harvard

Hoy, JF, Grund, B, Roediger, MP, Schwartz, AV, Shepherd, J, Avihingsanon, A, Badal-Faesen, S, De Wit, S, Jacoby, S, La Rosa, A, Pujari, S, Schechter, M, White, D, Engen, NW, Ensrud, K, Aagaard, PD, Carr, AJ & INSIGHT START Bone Mineral Density Substudy Group 2017, 'Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial' Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, bind 32, nr. 9, s. 1945-1955. https://doi.org/10.1002/jbmr.3183

APA

CBE

Hoy JF, Grund B, Roediger MP, Schwartz AV, Shepherd J, Avihingsanon A, Badal-Faesen S, De Wit S, Jacoby S, La Rosa A, Pujari S, Schechter M, White D, Engen NW, Ensrud K, Aagaard PD, Carr AJ, INSIGHT START Bone Mineral Density Substudy Group. 2017. Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 32(9):1945-1955. https://doi.org/10.1002/jbmr.3183

MLA

Vancouver

Author

Hoy, Jennifer F ; Grund, Birgit ; Roediger, Mollie P ; Schwartz, Ann V ; Shepherd, John ; Avihingsanon, Anchalee ; Badal-Faesen, Sharlaa ; De Wit, Stephane ; Jacoby, Simone ; La Rosa, Alberto ; Pujari, Sanjay ; Schechter, Mauro ; White, David ; Engen, Nicole Wyman ; Ensrud, Kristine ; Aagaard, Peer D ; Carr, Andrew J ; INSIGHT START Bone Mineral Density Substudy Group. / Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy : Findings from the START Bone Mineral Density Substudy, a Randomized Trial. I: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2017 ; Bind 32, Nr. 9. s. 1945-1955.

Bibtex

@article{ed59a2ce749741f58e8d97638f1760e8,
title = "Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial",
abstract = "Both HIV infection and antiretroviral therapy (ART) are associated with lower bone mineral density (BMD) and increased fracture risk. Because the relative contributions of ART and untreated HIV to BMD loss are unclear, it is important to quantify the effect of ART on bone. We compared the effect of early ART initiation (CD4 >500 cells/μL) with deferred ART on change in BMD in the START Bone Mineral Density substudy, a randomized trial evaluating the effect of immediate ART initiation versus deferring ART (to CD4 <350 cells/μL). BMD was measured annually at the lumbar spine and hip by dual-energy X-ray absorptiometry (DXA). Percent change in BMD by treatment assignment (intent-to-treat analysis) was estimated using longitudinal mixed models and linear regression. Baseline and follow-up DXA scans were available for 399 (195 immediate, 204 deferred) participants (median age 32 years, 80{\%} non-white, 26{\%} women, median CD4 count 642 cells/μL). ART (most commonly including tenofovir and efavirenz) was used for 95{\%} and 18{\%} of follow-up in the immediate and deferred ART groups, respectively. Through 2.2 years mean follow-up, immediate ART resulted in greater BMD declines than deferred ART at the hip (-2.5{\%} versus -1.0{\%}; difference -1.5{\%}, 95{\%} confidence interval [CI] -2.2 to -0.8, p < 0.001) and spine (-1.9{\%} versus -0.4{\%}; difference -1.6{\%}, 95{\%} CI -2.2 to -1.0, p < 0.001). BMD declines were greatest in the first year of ART. In the immediate ART group, spine BMD stabilized after year 1, whereas hip BMD declined progressively over 2 years. After year 1, BMD changes were similar in the immediate and deferred groups. No clinical, HIV-related, or ART characteristic predicted greater BMD loss in either group. All HIV treatment guidelines now recommend ART initiation at HIV diagnosis because of the reduced risk of serious clinical outcomes. Better understanding of the longer-term consequences of the observed reductions in BMD is needed.CLINICAL TRIALS REGISTRATION: NCT00867048. {\circledC} 2017 American Society for Bone and Mineral Research.",
keywords = "Journal Article",
author = "Hoy, {Jennifer F} and Birgit Grund and Roediger, {Mollie P} and Schwartz, {Ann V} and John Shepherd and Anchalee Avihingsanon and Sharlaa Badal-Faesen and {De Wit}, Stephane and Simone Jacoby and {La Rosa}, Alberto and Sanjay Pujari and Mauro Schechter and David White and Engen, {Nicole Wyman} and Kristine Ensrud and Aagaard, {Peer D} and Carr, {Andrew J} and {INSIGHT START Bone Mineral Density Substudy Group}",
note = "{\circledC} 2017 American Society for Bone and Mineral Research.",
year = "2017",
doi = "10.1002/jbmr.3183",
language = "English",
volume = "32",
pages = "1945--1955",
journal = "Journal of Bone and Mineral Research",
issn = "0884-0431",
publisher = "American Society for Bone and Mineral Research",
number = "9",

}

RIS

TY - JOUR

T1 - Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy

T2 - Findings from the START Bone Mineral Density Substudy, a Randomized Trial

AU - Hoy, Jennifer F

AU - Grund, Birgit

AU - Roediger, Mollie P

AU - Schwartz, Ann V

AU - Shepherd, John

AU - Avihingsanon, Anchalee

AU - Badal-Faesen, Sharlaa

AU - De Wit, Stephane

AU - Jacoby, Simone

AU - La Rosa, Alberto

AU - Pujari, Sanjay

AU - Schechter, Mauro

AU - White, David

AU - Engen, Nicole Wyman

AU - Ensrud, Kristine

AU - Aagaard, Peer D

AU - Carr, Andrew J

AU - INSIGHT START Bone Mineral Density Substudy Group

N1 - © 2017 American Society for Bone and Mineral Research.

PY - 2017

Y1 - 2017

N2 - Both HIV infection and antiretroviral therapy (ART) are associated with lower bone mineral density (BMD) and increased fracture risk. Because the relative contributions of ART and untreated HIV to BMD loss are unclear, it is important to quantify the effect of ART on bone. We compared the effect of early ART initiation (CD4 >500 cells/μL) with deferred ART on change in BMD in the START Bone Mineral Density substudy, a randomized trial evaluating the effect of immediate ART initiation versus deferring ART (to CD4 <350 cells/μL). BMD was measured annually at the lumbar spine and hip by dual-energy X-ray absorptiometry (DXA). Percent change in BMD by treatment assignment (intent-to-treat analysis) was estimated using longitudinal mixed models and linear regression. Baseline and follow-up DXA scans were available for 399 (195 immediate, 204 deferred) participants (median age 32 years, 80% non-white, 26% women, median CD4 count 642 cells/μL). ART (most commonly including tenofovir and efavirenz) was used for 95% and 18% of follow-up in the immediate and deferred ART groups, respectively. Through 2.2 years mean follow-up, immediate ART resulted in greater BMD declines than deferred ART at the hip (-2.5% versus -1.0%; difference -1.5%, 95% confidence interval [CI] -2.2 to -0.8, p < 0.001) and spine (-1.9% versus -0.4%; difference -1.6%, 95% CI -2.2 to -1.0, p < 0.001). BMD declines were greatest in the first year of ART. In the immediate ART group, spine BMD stabilized after year 1, whereas hip BMD declined progressively over 2 years. After year 1, BMD changes were similar in the immediate and deferred groups. No clinical, HIV-related, or ART characteristic predicted greater BMD loss in either group. All HIV treatment guidelines now recommend ART initiation at HIV diagnosis because of the reduced risk of serious clinical outcomes. Better understanding of the longer-term consequences of the observed reductions in BMD is needed.CLINICAL TRIALS REGISTRATION: NCT00867048. © 2017 American Society for Bone and Mineral Research.

AB - Both HIV infection and antiretroviral therapy (ART) are associated with lower bone mineral density (BMD) and increased fracture risk. Because the relative contributions of ART and untreated HIV to BMD loss are unclear, it is important to quantify the effect of ART on bone. We compared the effect of early ART initiation (CD4 >500 cells/μL) with deferred ART on change in BMD in the START Bone Mineral Density substudy, a randomized trial evaluating the effect of immediate ART initiation versus deferring ART (to CD4 <350 cells/μL). BMD was measured annually at the lumbar spine and hip by dual-energy X-ray absorptiometry (DXA). Percent change in BMD by treatment assignment (intent-to-treat analysis) was estimated using longitudinal mixed models and linear regression. Baseline and follow-up DXA scans were available for 399 (195 immediate, 204 deferred) participants (median age 32 years, 80% non-white, 26% women, median CD4 count 642 cells/μL). ART (most commonly including tenofovir and efavirenz) was used for 95% and 18% of follow-up in the immediate and deferred ART groups, respectively. Through 2.2 years mean follow-up, immediate ART resulted in greater BMD declines than deferred ART at the hip (-2.5% versus -1.0%; difference -1.5%, 95% confidence interval [CI] -2.2 to -0.8, p < 0.001) and spine (-1.9% versus -0.4%; difference -1.6%, 95% CI -2.2 to -1.0, p < 0.001). BMD declines were greatest in the first year of ART. In the immediate ART group, spine BMD stabilized after year 1, whereas hip BMD declined progressively over 2 years. After year 1, BMD changes were similar in the immediate and deferred groups. No clinical, HIV-related, or ART characteristic predicted greater BMD loss in either group. All HIV treatment guidelines now recommend ART initiation at HIV diagnosis because of the reduced risk of serious clinical outcomes. Better understanding of the longer-term consequences of the observed reductions in BMD is needed.CLINICAL TRIALS REGISTRATION: NCT00867048. © 2017 American Society for Bone and Mineral Research.

KW - Journal Article

U2 - 10.1002/jbmr.3183

DO - 10.1002/jbmr.3183

M3 - Journal article

VL - 32

SP - 1945

EP - 1955

JO - Journal of Bone and Mineral Research

JF - Journal of Bone and Mineral Research

SN - 0884-0431

IS - 9

ER -

ID: 50649525