Changes in bone microarchitecture with abacavir--lamivudine versus tenofovir disoproxil fumarate--emtricitabine in adults living with HIV.
Changes in bone microarchitecture with abacavir--lamivudine versus tenofovir disoproxil fumarate--emtricitabine in adults living with HIV.
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阿巴卡韦（拉米夫定）与富马酸替诺福韦二吡呋酯（恩曲他滨）治疗成人艾滋病毒感染者的骨微结构变化。
DOI：
10.1097/qad.0000000000002592
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Maalouf,NaimM
中科院分区：
文献类型：
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作者：
Bedimo,RogerJ;Adams-Huet,Beverley;Nguyen,Van;Moore-Matthews,Dindi;Poindexter,John;Maalouf,NaimM
HIV 感染者中骨质疏松性骨折的发生率也高于年龄匹配的未感染者 [7-9]。然而，与 ART 相关的 BMD 下降从未被证实可以作为 HIV 患者骨质疏松性骨折的预测因子。我们假设，除了 BMD 之外，与 TDF 相关的骨质疏松性骨折风险可能是由骨微结构的改变驱动的。骨小梁评分 (TBS) 是一种根据双 X 射线吸收测量 (DXA) 图像测量骨微结构的新方法 [10, 11]。 TBS 是通过重新分析 AP 腰椎 DXA 图像获得的，即使在调整 BMD 后也是经过验证的骨质疏松性骨折预测指标 [12]。 TBS 现在被作为骨折风险预测 FRAX 算法中的独立风险因素纳入其中 [13]，并且即使在没有降低 BMD 的情况下，也可能改善与骨折风险增加相关的情况下的骨折风险预测 [14-17]。由于之前未评估过启动不同抗逆转录病毒治疗方案对 TBS 的影响，因此我们旨在比较未接受过抗逆转录病毒治疗的受试者在启动含 TDF 或含阿巴卡韦 (ABC) 抗逆转录病毒治疗方案时 TBS 的变化。我们利用了 ASSERT 试验中收集的 BMD 数据，这是一项在欧洲进行的多中心、随机、开放标签研究。符合条件的未接受过 ART 的 HIV-1 感染成年受试者被随机分配至阿巴卡韦/拉米夫定 (ABC/3TC) 或替诺福韦/恩曲他滨 (TDF/FTC) 联合依非韦伦 (EFV)[3]。在基线以及 ART 开始后第 24 周和第 48 周进行腰椎和髋部 DXA 扫描。我们评估了使用 Hologic 密度计捕获的 LS DXA 图像子集的 TBS 分数。我们使用混合效应重复测量模型来比较治疗组之间从基线到第 48 周的 BMD 和 TBS 变化，并控制基线值、年龄、BMI、种族和性别。 365 个中总共 158 个（75 个 TDF/FTC，83 个 ABC/3TC）
The incidence of osteoporotic fractures is also higher among HIV-infected patients than in age-matched uninfected subjects [7–9]. However, the decline in BMD associated with ART has never been validated as a osteoporotic fracture predictor in HIV patients. We hypothesized that beyond BMD, osteoporotic fracture risk associated with TDF might be driven by alterations in bone microarchitecture.Trabecular bone score (TBS) is a novel measurement of bone microarchitecture from dual X-ray absorptiometry (DXA) images [10, 11]. TBS is obtained by re-analysis of AP lumbar spine DXA images, and is a proven osteoporotic fracture predictor, even after adjusting for BMD [12]. TBS is now included as an independent risk factor in the FRAX algorithm for fracture risk prediction [13], and might improve fracture risk prediction in conditions associated with increased fracture risk, even in the absence of reduced BMD [14–17]. As the impact of initiating different antiretroviral regimens on TBS not been previously evaluated, we aimed to compare changes in TBS among antiretroviral-naıve subjects initiating TDF-containing or Abacavir (ABC)-containing antiretroviral regimens. We utilized BMD data collected in the ASSERT trial, a multicenter, randomized, open-label study conducted in Europe. Eligible ART-naive, HIV-1-infected adult subjects were randomized to abacavir/lamivudine (ABC/3TC) or tenofovir/emtricitabine (TDF/FTC) administered with efavirenz (EFV)[3]. DXA scans of lumbar spine and hip were conducted at baseline, and weeks 24 and 48 after ART initiation. We assessed TBS scores from the subset of LS DXA images captured with a Hologic densitometer. We used mixed effects repeated measure models to compare changes in BMD and TBS from baseline to week 48 between treatment arms, controlling for baseline values, age, BMI, race and sex. A total of 158 (75 TDF/FTC, 83 ABC/3TC) of the 365