Tenofovir-Associated Bone Adverse Outcomes among a US National Historical Cohort of HIV-Infected Veterans: Risk Modification by Concomitant Antiretrovirals
| العنوان: | Tenofovir-Associated Bone Adverse Outcomes among a US National Historical Cohort of HIV-Infected Veterans: Risk Modification by Concomitant Antiretrovirals |
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| المؤلفون: | Adam P. Bress, Joanne LaFleur, Kristin Knippenberg, Jacob Crook, Heather Nyman, Pablo Tebas, Stephen Esker, Lisa Rosenblatt, Joel Myers, Roger Bedimo |
| المصدر: | Infectious Diseases and Therapy |
| بيانات النشر: | Springer Science and Business Media LLC, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Efavirenz, Bone disease, Osteoporosis, Emtricitabine, 03 medical and health sciences, chemistry.chemical_compound, Tenofovir disoproxil fumarate, Internal medicine, medicine, Original Research, Veterans, business.industry, Cobicistat, Hazard ratio, medicine.disease, 030112 virology, Regimen, Fracture, Infectious Diseases, chemistry, Rilpivirine, business, medicine.drug |
| الوصف: | Introduction Tenofovir disoproxil fumarate (TDF) has been associated with greater incidences of bone complications, which might be modified by some concomitantly administered antiretrovirals, possibly by their effect on tenofovir concentrations. We compared bone adverse outcomes among treatment-naïve HIV-infected US veterans initiating efavirenz (EFV)-containing TDF/emtricitabine (FTC) regimens versus those initiating non-EFV-containing TDF/FTC regimens. Methods Using national Veterans Health Administration clinical and administrative data sets, we identified a cohort of treatment-naïve HIV-infected veterans without bone disease who initiated therapy with TDF/FTC plus EFV, rilpivirine, elvitegravir/cobicistat, or ritonavir-boosted protease inhibitors in 2003–2015. The primary composite adverse bone outcome was the unadjusted incidence rate (IR) of osteoporosis, osteopenia, or fragility fracture (any hip, wrist, or spine fracture). To account for selection bias and confounding, we used inverse probability of treatment-weighted Cox proportional hazards regression models to calculate adjusted hazard ratios (HRs) for each outcome associated with EFV + TDF/FTC versus each non-EFV-containing TDF/FTC regimen. Results Of 33,048 HIV-positive veterans, 7161 initiated a TDF/FTC-containing regimen (mean age, 50 years; baseline CD4 100,000 copies/ml, 22.3%; mean follow-up, 13.0 months). Of these, 4137 initiated EFV- and 3024 non-EFV-containing regimens. Veterans initiating EFV- versus non-EFV-containing TDF/FTC regimens had a lower IR of the composite bone outcome (29.3 vs. 41.4 per 1000 patient-years), with significant risk reductions for this outcome [HR, 0.69; 95% confidence interval (CI), 0.58–0.83] and fragility fracture (HR, 0.59; 95% CI, 0.44–0.78). Conclusion EFV + TDF/FTC is associated with a lower risk of adverse bone outcomes compared with other TDF-containing regimens in the VHA. Funding Bristol-Myers Squibb. Electronic supplementary material The online version of this article (10.1007/s40121-018-0194-1) contains supplementary material, which is available to authorized users. |
| تدمد: | 2193-6382 2193-8229 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::32169762a1989170c9100e3c8a4f8e50 https://doi.org/10.1007/s40121-018-0194-1 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....32169762a1989170c9100e3c8a4f8e50 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 21936382 21938229 |
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