Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Publication

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Journal Paper/Review - Aug 22, 2017

Bayard Cornelia, Hasse Barbara, Tarr Philip E, Fux Christoph A, Di Benedetto Caroline, Staehelin Cornelia, Weber Rainer, Hoffmann Matthias, Moulin Estelle, Lecompte Thanh, Flepp Markus, Ledergerber Bruno, Swiss HIV Cohort Study

Citation

Bayard C, Hasse B, Tarr P, Fux C, Di Benedetto C, Staehelin C, Weber R, Hoffmann M, Moulin E, Lecompte T, Flepp M, Ledergerber B, Swiss HIV Cohort Study. Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study. Open Forum Infect Dis 2017; 4:ofx177.

Type

Journal Paper/Review (English)

Journal

Open Forum Infect Dis 2017; 4

Publication Date

Aug 22, 2017

Issn Print

2328-8957

Pages

ofx177

Brief description/objective

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.