Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study
Author:
Bayard Cornelia1, Ledergerber Bruno1, Flepp Markus2, Lecompte Thanh3, Moulin Estelle4, Hoffmann Matthias5, Weber Rainer1, Staehelin Cornelia6, Di Benedetto Caroline7, Fux Christoph A8, Tarr Philip E9, Hasse Barbara1, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Calmy A, Cavassini M, Ciuffi A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Günthard HF, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos RD, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner KJ, Müller N, Nicca D, Pantaleo G, Paioni P, Rauch A, Rudin C, Scherrer AU, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Wandeler G, Weber R, Yerly S,
Affiliation:
1. Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland 2. Center for Infectious Diseases Zurich, Zurich, Switzerland 3. Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland 4. Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland 5. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St. Gallen, Switzerland 6. Division of Infectious Diseases and Hospital Epidemiology, University and Inselspital Berne, Berne, Switzerland 7. Division of Infectious Diseases, Regional Hospital, Lugano, Switzerland 8. Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland 9. Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland Bruderholz, University of Basel, Bruderholz, Switzerland
Abstract
Abstract
Background
HIV-infected individuals have an increased risk of avascular bone necrosis (AVN). Antiretroviral therapy (ART) and particularly protease inhibitors (PI) have been implicated as a risk factor. We aimed to study the associations of ART with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS).
Methods
We used incidence density sampling to perform a case control study within the Swiss HIV Cohort Study (SHCS) comparing prospectively collected AVN cases and controls by conditional logistic regression analysis. To evaluate the effect of ART, multivariable models were adjusted for HIV transmission risk group, age, alcohol consumption, use of corticosteroids, CD4 nadir, maximum viral load, and pancreatitis.
Results
We compared 74 AVN cases and 145 controls. Associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1–10), alcohol consumption (OR, 2.7; 95% CI, 1.3–5.7), and hyperlipidemia (OR, 3.6; 95% CI, 1.4–9.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4; 95% CI, 1.4–14) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN.
Conclusions
In the HIV-infected population, a combination of risk factors such as heterosexual HIV acquisition, moderate to severe alcohol intake, and hyperlipidemia seem to contribute to AVN. ART does not seem to be a relevant risk factor for AVN. The association of prolonged TDF exposure with AVN needs to be confirmed.
Funder
Swiss National Science Foundation
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Cited by
10 articles.
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