Stable bone mineral density over 6 years in HIV-infected men treated with highly active antiretroviral therapy (HAART)

Objective Most longitudinal studies of bone mineral density (BMD) in HIV-infected cohorts have been of short duration, typically 12 years. Some studies, especially of cohorts treated with highly active antiretroviral therapy (HAART), report short-term stable or increasing BMD, but other studies, often in cohorts initiating HAART, report short-term losses in BMD. We assessed BMD changes over the medium term in HIV-infected men already established on HAART at baseline. Design Six-year, prospective, longitudinal study. Subjects Forty-four HIV-infected men treated with HAART and 37 uninfected, healthy controls. Measurements Participants had measurements of BMD at baseline, 2 and 6 years. Results In the HIV-infected men at baseline, the mean age was 49 years, the mean duration of infection was 8 years, and the mean duration of HAART was 50 months. Over 6 years of follow-up, there was a greater increase in lumbar spine BMD (5.3%, 95% CI 3.8-6.5%) in the HIV-infected men compared with controls (0.3%, 95% CI) 1.0 to 1.6%), P < 0.001. There was no difference between the groups in the change in BMD over time at the total hip (HIV group:) 0.6%, 95% CI) 1.7 to 0.4%, controls) 1.0%, 95% CI) 2.2 to 0%, P = 0 8) or at the total body (HIV group, 0.3%, 95% CI) 0.3 to 1.0%; controls, 0.5%, 95% CI) 0.2 to 1.1%, P = 0.15). Lean mass increased in the HIV group, but not in the controls. Conclusions There was no evidence of accelerated bone loss over 6 years in middle-aged, HIV-infected men treated with HAART. For such patients, routine monitoring of BMD is not necessary over the short/medium term.