Rajesh T. Gandhi, MD reviewing Ofotukun I et al. Clin Infect Dis 2016 May 18.

One dose of a long-acting bisphosphonate prevented the decline in patients initiating antiretroviral therapy.

After initiation of antiretroviral therapy (ART), HIV-infected patients experience substantial declines in bone mineral density (BMD). The largest losses occur in patients who initiate a tenofovir disoproxil fumarate (TDF)-containing regimen, but even those who start more bone-friendly medications, such as abacavir or tenofovir alafenamide, suffer declines.

To assess whether giving a bisphosphonate, which inhibits bone resorption, can prevent ART-induced BMD loss, investigators conducted a randomized, controlled, double-blind, phase IIb trial involving 63 HIV-infected patients initiating ART treatment with TDF/FTC plus ritonavir-boosted atazanavir. Most participants were black (84%) and male (79%), and 67% were current smokers (a risk factor for developing osteoporosis). On the day ART was started, patients received either a single intravenous infusion of zoledronic acid or placebo.

Following initiation of ART, a marker of bone turnover was significantly lower in patients receiving zoledronic acid versus placebo. From baseline to week 48, lumbar-spine BMD, assessed using dual-energy x-ray absorptiometry (DXA) scans, declined 4.4% in patients receiving placebo, but remained unchanged in those receiving zoledronic acid. Zoledronic acid led to an 11% increase in lumbar spine BMD at week 48 relative to placebo. Similar findings were seen at the hip and femoral neck.

CITATION(S):

Ofotukun I et al. A single-dose zoledronic acid infusion prevents antiretroviral therapy–induced bone loss in treatment-naive HIV-infected patients: A phase IIb trial. Clin Infect Dis 2016 May 18; [e-pub]. 

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