Long-term Bone Mineral Density Changes in Antiretroviral-treated HIV-Infected Individuals Grant P, Kitch D, McComsey G, Collier A, Koletar S, Erlandson K, Yin M, Bartali B, Ha B, Melbourne K, Brown T

Background/Methods Fracture rates increased in HIV Rapid BMD decline during first 2 years of ART Limited data on longer term changes Compared BMD change rate during ~ 7.5 years of ART to change rate in two HIV- uninfected cohorts (BACH/Bone and WIHS) Adjusted for age, sex, race, BMI, exercise level, and cigarette and alcohol use Risk factors for BMD decline in HIV

ACTG A5318 (n=97)Controls (n=614) Age at Initial DXA – years40 (31, 44)46 (38, 54) % Male86%87% Race/ethnicity White Non-Hispanic Black Non-Hispanic Hispanic (Regardless of Race) 47% 34% 14% 35% 33% 31% BMI - kg/m 2 At Initial DXA24 (22, 27)28 (25, 32) Years between Initial /Final DXA7.6 (7.3, 7.8)6.9 (6.5, 7.3) CD4 Count – cells/µL At Initial DXA At Final DXA 247 (130, 333) 598 (408, 707) N.A % HIV RNA Level At Final DXA <200c/mL 86%N.A. Cumulative TDF Use – Years5.8 (1.1, 7.4)N.A. Cumulative PI Use – Years3.7 (0, 7.4)N.A.

Change in LS BMD by Serostatus

Change in TH BMD by Serostatus

Adjusted Analyses - Summary During “early” period, HIV-infected individuals have greater adjusted BMD loss than uninfected at both LS and TH During “late” period HIV-infected have greater adjusted BMD loss at LS but not TH In HIV, BMD decline significantly slows after initial steep decline but continues through 7.5 years of follow-up

Multivariable Analyses in HIV - Summary During early period, HIV-related factors associated with BMD loss (lower CD4, higher VL, TDF use) During late period, total lean body mass, but not HIV-related factors, associated with BMD loss

Conclusions Bone loss in HIV will likely remain an issue even with more bone-friendly regimens With aging of HIV-infected individuals, interventions to maintain skeletal health should be examined