Trial reportAIDS (London, England)2009
Continuous antiretroviral therapy decreases bone mineral density.
Trial report in AIDS (London, England), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
82 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Incident fractures in HIV-infected individuals: a systematic review and meta-analysis.AIDS (London, England) · 2013Pooled it
- Bone loss in hepatitis B virus-infected patients can be associated with greater osteoclastic activity independently of the retroviral use.Scientific reports · 2021Trial
- Safety and Efficacy of 48 and 96 Weeks of Alendronate in Children and Adolescents With Perinatal Human Immunodeficiency Virus Infection and Low Bone Mineral Density for Age.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Alendronate Improves Bone Mineral Density in Children and Adolescents Perinatally Infected With Human Immunodeficiency Virus With Low Bone Mineral Density for Age.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Trial
- Trial
- Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2017Trial
- Increased bone resorption during tenofovir plus lopinavir/ritonavir therapy in Chinese individuals with HIV.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2015Trial
- Low baseline CD4+ count is associated with greater bone mineral density loss after antiretroviral therapy initiation.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2013Trial
- Bone mineral density in HIV participants randomized to raltegravir and lopinavir/ritonavir compared with standard second line therapy.AIDS (London, England) · 2013Trial
- Interruption or deferral of antiretroviral therapy reduces markers of bone turnover compared with continuous therapy: The SMART body composition substudy.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2013Trial
- Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial.PLoS medicine · 2012Trial
- Comparison of bone and renal effects in HIV-infected adults switching to abacavir or tenofovir based therapy in a randomized trial.PloS one · 2012Trial
- Relationships Between Physical Activity and Bone Density in People Living with HIV: Results from the SATURN-HIV Study.The Journal of the Association of Nurses in AIDS Care : JANACTrial
- Investigation of Osteoporosis in Persons Living with Human Immunodeficiency Virus: The HOST Study.Calcified tissue international · 2025Article
- Osteoimmunology: Crosstalk Between T Cells and Osteoclasts in Osteoporosis.Clinical reviews in allergy & immunology · 2025Review
- Bone Disease in HIV: Need for Early Diagnosis and Prevention.Life (Basel, Switzerland) · 2024Review
- Non-traumatic Bilateral Lower Limb Fractures in Human Immunodeficiency Virus Positive Individuals on Long-Term Antiretroviral Therapy: Two Case Reports and Literature Review.Journal of orthopaedic case reports · 2023Article
- The effect of anti-retroviral therapy on fracture healing : an in vivo animal model.Bone & joint research · 2022Article
- People living with HIV have low trabecular bone mineral density, high bone marrow adiposity, and poor trabecular bone microarchitecture at the proximal femur.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022Article
- "We are Getting Those Old People Things." Polypharmacy Management and Medication Adherence Among Adult HIV Patients with Multiple Comorbidities: A Qualitative Study.Patient preference and adherence · 2022Article
22 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
objectivesTo assess the effects of antiretroviral therapy (ART) on bone mineral density (BMD)
designRandomized comparison of continuous ART (viral suppression group; VS) with intermittent ART (drug conservation group; DC)
settingOutpatient clinics in the United States, Australia, and Spain.
participantsParticipants in the Strategies for Management of Antiretroviral Therapy (SMART) Body Composition substudy.
main outcome measuresAnnual hip and spine BMD by dual-energy radiographic absorptiometry (DXA) and spine BMD by quantitative computed tomography (qCT).
methodsComparisons were by intention-to-treat analysis, using longitudinal models for change in BMD. Risk factors for BMD loss were evaluated.
resultsThe 214 participants (median 44 years, 19% female participants, 73% on ART; median T-scores -0.5 total hip, -0.7 spine DXA, -0.9 spine qCT; 98 randomized to VS and 116 to DC) were followed for a mean 2.4 years. With continuous ART, BMD declined per year by 0.8% (hip), 0.4% (spine DXA), and 2.4% (spine qCT). BMD declined significantly less with intermittent ART. Estimated DC minus VS group differences in mean BMD change through follow-up were 1.4% [hip; 95% confidence interval (CI) 0.6-2.3; P = 0.002], 1.3% (spine DXA; 95% CI 0.1-2.4, P = 0.03), and 3.0% (spine qCT; 95% CI 0.8-5.2, P = 0.007). No consistent drug-specific association with BMD decline was found. In the parent study, 10 of 2753 participants in the VS group and two of 2720 in the DC group reported serious fractures (hazard ratio 4.9; 95% CI 1.1-22.5; P = 0.04).
conclusionContinuous ART is associated with decline in BMD and possibly more fractures relative to intermittent, CD4 cell count-guided ART.
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