446. HIV+ve Patients Who Develop Fragility Fractures Spend More ART Days on TDF and/or ATV than HIV+ve Patients Without Fractures
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1
Background:ART’s (antiretroviral therapy) role in fragility fractures has not been defined. Commonly, surrogate markers such as bone mineral density rather than fracture end points have been utilized in study designs. We sought to investigate factors (including ART agents) associated with fragility fractures in a US cohort 

Methods:A nested case-control study was conducted at the UAB 1917 clinic using incidence density sampling to select controls.  This eliminated biases associated with changing trends in HIV presentation & provider prescribing patterns. Cases were identified using WHO criteria for fragility fractures and matched with controls on age, sex & race. Descriptive statistics & bivariate analyses were used to compare the study populations 

Results:23 cases & 69 controls were identified; mean age was 44+1 years, 74% were male & 61% white. On univariate analysis no statistical difference (p>0.05) was observed between the groups at time of fracture with regards to CD4 (400+204 v 400+288); CD4 nadir (161+121 v 145 +167) & Total Cholesterol (182+60 v 199+53). HIV viral load was higher in controls (43,148 v 5396; p=0.048). Prevalence of co-morbid ETOH use, renal dysfunction & hypogonadism were similar (p>0.05). T-test comparisons of mean dosage days on each ART agent were completed (Table). Only time on TDF (499 +525 v 304+427 p=0.046.) & time on ATV (249+497 v 124+399 p=0.019) were found to be greater among cases.

Comparison of ART use btn HIV +ve pts with fragility fractures & HIV+ve pts without fractures

 

Cases(n=23)

Controls(n=69)

P-value

EFV-    Ever taken

     -    MD+SD

15(65%)

692+903

37(53%)

547+789

NS

ABC -    Ever taken

       -     MD+SD

7(30%)

346+1170

21(30%)

322+652

NS

FTC-    Ever taken

       -     MD+SD

10(43%)

175+292

28(40%)

141+309

NS

TDF-    Ever taken

       -     MD+SD

17(74%)

499+526

40(58%)

304+427

0.046

3TC-    Ever taken

       -     MD+SD

17(74%)

1341+1433

49(71%)

1248+1211

NS

ATV-   Ever taken

       -     MD+SD

9(39%)

249+497

16(23%)

124+339

0.019

LPV-    Ever taken

       -     MD+SD

5(22%)

145+374

13(19%)

160+504

NS

RTV-   Ever taken

       -     MD+SD

14(61%)

514+573

29(42%)

285+625

NS

MD+SD- Mean days + Standard deviation

Conclusion:HIV+ patients with fragility fractures received more dosage days of TDF & ATV than their counterparts without fractures. Studies are warranted to further define the role of these agents in fragility fractures


Subject Category: H. HIV/AIDS and other retroviruses

Senu Apewokin, MD, Medicine, UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES, Little Rock, AR, James H. Willig, MD, MSPH, UAB, Birmingham, AL, Michael J. Mugavero, MD, MHSc, University of Alabama at Birmingham, Birmingham, AL and Michael S. Saag, MD, FIDSA, University of Alabama, Birmingham, AL

Disclosures:

S. Apewokin, None

J. H. Willig, Bristol Myers Squibb: Grant Investigator, Research grant and Research support
Definicare: Grant Investigator, Research grant
Gilead: Grant Investigator, Research support
Pfizer: Grant Investigator, Research support

M. J. Mugavero, Bristol Myers Squibb: Grant Investigator and Scientific Advisor, Consulting fee and Research grant
Gilead Sciences: Research Contractor and Scientific Advisor, Consulting fee
Tibotec Therapeutics: Grant Investigator, Research grant
Pfizer: Grant Investigator, Research grant
Definicare: Grant Investigator, Research grant

M. S. Saag, Merck: Consultant and Scientific Advisor, Consulting fee
Adrea Biosciences: Consultant and Scientific Advisor, Consulting fee
Boehringer: Consultant and Scientific Advisor, Consulting fee
Ingelheim: Consultant and Scientific Advisor, Consulting fee
Bristol-Myers Squibb: Consultant and Scientific Advisor, Consulting fee
Gilead: Consultant and Scientific Advisor, Consulting fee
GSK: Consultant and Scientific Advisor, Consulting fee
Pfizer: Consultant and Scientific Advisor, Consulting fee
Vliv: Consultant and Scientific Advisor, Consulting fee
Tibotec: Consultant and Scientific Advisor, Consulting fee
Vertex: Scientific Advisor, Consulting fee
Monogram Biosciences: Research Contractor, Research support
NIH/NIAID: Grant Investigator, Grant recipient

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.