Loss of bone mineral density after antiretroviral therapy initiation, independent of antiretroviral regimen

Todd T. Brown, Grace A. McComsey, Martin S. King, Roula B. Qaqish, Barry M. Bernstein, Barbara A. Da Silva

Research output: Contribution to journalArticlepeer-review


BACKGROUND:: Decreased bone mineral density (BMD) has been described in HIV-infected patients initiating antiretroviral therapy (ART), but the contributions of ART and immunologic and/or virologic factors remain unclear. METHODS:: We compared total BMD changes over 96 weeks in 106 ART-naive HIV-infected subjects who were randomized to receive efavirenz (EFV) + zidovudine/lamivudine (n = 32) or lopinavir/ritonavir (LPV/r) + zidovudine/lamivudine induction (n = 74) for 24-48 weeks followed by LPV/r monotherapy. We also sought to identify factors associated with BMD loss, including markers of systemic inflammation [soluble tumor necrosis factor-α receptors (sTNFR I and II)]. RESULTS:: After 96 weeks, the mean percent change from baseline in total BMD was -2.5% (LPV/r) and -2.3% (EFV) (P < 0.01 for within-group changes in either arm; P = 0.86 for between-group differences). No alteration in the rate of BMD change was observed upon simplification to LPV/r monotherapy. Although soluble tumor necrosis factor-α receptor II concentrations at baseline and 24 weeks were at least marginally associated with subsequent changes in BMD (P = 0.06 and P = 0.028, respectively), these associations were no longer significant after adjustment for CD4 T cell count. Subjects with lower baseline CD4 T cell count, non-black race, and higher baseline glucose demonstrated a higher risk for >5% decrease in BMD. CONCLUSIONS:: Similar decreases in BMD over 96 weeks occurred in ART-naive subjects receiving either EFV-based regimen or LPV/r-based regimen, which was not altered by simplification to LPV/r monotherapy and was unrelated to markers of tumor necrosis factor-α activity.

Original languageEnglish (US)
Pages (from-to)554-561
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number5
StatePublished - Aug 2009


  • Bone mineral density
  • DXA
  • Efavirenz
  • Lopinavir/ritonavir

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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