Document Detail


Interruption or deferral of antiretroviral therapy reduces markers of bone turnover compared with continuous therapy: The SMART body composition substudy.
MedLine Citation:
PMID:  23299909     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Bone mineral density (BMD) declines significantly in HIV patients on antiretroviral therapy (ART). We compared the effects of intermittent versus continuous ART on markers of bone turnover in the Body Composition substudy of the Strategies for Management of AntiRetroviral Therapy (SMART) trial and determined whether early changes in markers predicted subsequent change in BMD. For 202 participants (median age 44 years, 17% female, 74% on ART) randomized to continuous or intermittent ART, plasma markers of inflammation and bone turnover were evaluated at baseline and months 4 and 12; BMD at the spine (dual-energy X-ray absorptiometry [DXA] and computed tomography) and hip (DXA) was evaluated annually. Compared with the continuous ART group, mean bone-specific alkaline phosphatase (bALP), osteocalcin, procollagen type 1 N-terminal propeptide (P1NP), N-terminal cross-linking telopeptide of type 1 collagen (NTX), and C-terminal cross-linking telopeptide of type 1 collagen (βCTX) decreased significantly in the intermittent ART group, whereas RANKL and the RANKL:osteoprotegerin (OPG) ratio increased (all p ≤ 0.002 at month 4 and month 12). Increases in bALP, osteocalcin, P1NP, NTX, and βCTX at month 4 predicted decrease in hip BMD at month 12, whereas increases in RANKL and the RANKL:OPG ratio at month 4 predicted increase in hip and spine BMD at month 12. This study has shown that compared with continuous ART, interruption of ART results in a reduction in markers of bone turnover and increase in BMD at hip and spine, and that early changes in markers of bone turnover predict BMD changes at 12 months.
Authors:
Jennifer Hoy; Birgit Grund; Mollie Roediger; Kristine E Ensrud; Indira Brar; Robert Colebunders; Nathalie De Castro; Margaret Johnson; Anjali Sharma; Andrew Carr;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research     Volume:  28     ISSN:  1523-4681     ISO Abbreviation:  J. Bone Miner. Res.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-22     Completed Date:  2013-12-09     Revised Date:  2014-06-26    
Medline Journal Info:
Nlm Unique ID:  8610640     Medline TA:  J Bone Miner Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1264-74     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society for Bone and Mineral Research.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00027352
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MeSH Terms
Descriptor/Qualifier:
Adult
Alkaline Phosphatase / blood
Anti-Retroviral Agents / administration & dosage
Australia
Biological Markers / blood
Bone Density*
Collagen Type I / blood
Female
Follow-Up Studies
HIV Infections / blood*,  complications,  drug therapy,  pathology,  physiopathology
Humans
Male
Middle Aged
Osteitis / blood*,  etiology,  pathology,  physiopathology
Osteocalcin / blood
Osteoprotegerin / blood
RANK Ligand / blood
Spain
Spinal Diseases / blood*,  etiology,  pathology,  physiopathology
United States
Grant Support
ID/Acronym/Agency:
U01 AI042170/AI/NIAID NIH HHS; U01 AI046362/AI/NIAID NIH HHS; U01 AI068641/AI/NIAID NIH HHS; U01-AI068641/AI/NIAID NIH HHS; U01AI042170/AI/NIAID NIH HHS; U01AI46362/AI/NIAID NIH HHS; UM1 AI068641/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents; 0/Biological Markers; 0/Collagen Type I; 0/Osteoprotegerin; 0/RANK Ligand; 0/TNFRSF11B protein, human; 0/TNFSF11 protein, human; 104982-03-8/Osteocalcin; EC 3.1.3.1/Alkaline Phosphatase
Comments/Corrections

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