Early loss of bone mineral density is correlated with a gain of fat mass in patients starting a protease inhibitor containing regimen: the prospective Lipotrip study

BMC Infectious Diseases

Bertrand Perret⁶  Jacques Bernard¹  Cyrille Delpierre⁷  Fabrice Marion-Latard⁴  Patrice Massip¹  Bruno Marchou¹  François Prévoteau³  Martine Obadia¹  Florian Busato²  Laurence Mabile⁵  Anne Genoux⁶  Jean-Bernard Ruidavets⁷  Eric Bonnet⁵ 

[1] CHU Toulouse, Hôpital Purpan, Service des Maladies Infectieuses et Tropicales, Toulouse, F 31300, France;CH Tarbes, Service des Maladies Infectieuses, Tarbes, F 64000, France;CHU Toulouse, Hôpital La Grave, Service de Dermato-vénérologie, Toulouse, F 31000, France;CHU Toulouse, Hôpital Larrey, Service de Médecine du Sport, Toulouse, F 31300, France;INSERM, U1048, Toulouse, F 31300, France;CHU Toulouse, Hôpital Purpt fédératif de Biologie, Toulouse, F 31300, France;Département Epidémiologie, CHU Toulouse, Toulouse, F 31300, France

关键词: Dyslipidaemia;    Lipodystrophy;    Bone metabolism;    Bone mineral density;    Osteoporosis;    Osteopenia;    Antiretroviral treatment (ART);    HIV;   

Others  :  1147511
DOI  :  10.1186/1471-2334-13-293

 received in 2012-12-24, accepted in 2013-05-17,  发布年份 2013

【 摘 要 】

Background

HIV-infected patients starting antiretroviral treatment (ART) experience deep and early disorders in fat and bone metabolism, leading to concomitant changes in fat mass and bone mineral density.

Methods

We conducted a prospective study in treatment-naive HIV-infected patients randomized to receive two nucleoside reverse transcriptase inhibitors in combination with either a protease inhibitor (PI) or a non-nucleosidic reverse transcriptase inhibitor (NNRTI), to evaluate early changes in body composition, bone mineral density and metabolic markers as differentially induced by antiretroviral therapies. We measured changes in markers of carbohydrate, of fat and bone metabolism, and, using dual-emission X-ray absorptiometry (DXA), body composition and bone mineral density (BMD). Complete data on changes between baseline and after 21 months treatment were available for 35 patients (16 in the PI group and 19 in the NNRTI group).

Results

A significant gain in BMI and in total and lower limb fat mass was recorded only in patients receiving PI. A loss of lumbar BMD was observed in both groups, being higher with PI. Plasma markers of bone metabolism (alkaline phosphatase, osteocalcin, collagen crosslaps) and levels of parathormone and of 1,25diOH-vitamin D3 significantly increased in both groups, concomitant with a decline in 25OH-vitamin D3. Lipids and glucose levels increased in both groups but rise in triglyceride was more pronounced with PI. A correlation between loss of BMD and gain of fat mass is observed in patients starting PI.

Conclusions

We evidenced an early effect of ART on lipid and bone metabolisms. PI lead to a significant gain in fat mass correlated with a sharp drop in BMD but active bone remodelling is evident with all antiretroviral treatments, associated with low vitamin D levels and hyperparathyroidism. In parallel, signs of metabolic restoration are evident. However, early increases in lean and fat mass, triglycerides, waist circumference and leptin are much more pronounced with PI.

【 授权许可】

   
2013 Bonnet et al.; licensee BioMed Central Ltd.

【 图 表 】

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