Kalayjian, Robert C.Albert, Jeffrey M.Cremers, SergeGupta, Samir K.McComsey, Grace A.Klingman, Karin L.Fichtenbaum, Carl J.Brown, Todd T.Taiwo, Babafemi O.2020-01-072020-01-072018-11-13Kalayjian, R. C., Albert, J. M., Cremers, S., Gupta, S. K., McComsey, G. A., Klingman, K. L., … ACTG A5224s, A5303 Teams (2018). Women have enhanced bone loss associated with phosphaturia and CD4+ cell restoration during initial antiretroviral therapy. AIDS (London, England), 32(17), 2517–2524. doi:10.1097/QAD.0000000000001995https://hdl.handle.net/1805/21765OBJECTIVE: We compared bone mineral density (BMD) changes and their correlates, between men and women participating in two randomized trials of initial [antiretroviral therapy (ART)] regimens, with or without tenofovir disoproxil fumarate (TDF). METHODS: Covariates in linear regression models of 48-week hip and spine %BMD changes, by dual energy X-ray absorptiometry, included baseline and 48-week changes in plasma viral load, CD4 cells, plasma C-terminal telopeptide, procollagen 1 N-terminal propeptide and glomerular filtration rates, and the 48-week area under the curve of fractional excretion of phosphate. RESULTS: Despite overall hip and spine BMD declines of 2.8 and 2.9%, respectively, plasma viral load suppression to less than 50 vs. at least 50 copies/ml was associated 1.0% (P = 0.02) and 0.8% (P = 0.01) less BMD decline. Women had lower baseline spine (P = 0.04; n = 59 women, 418 men) and hip BMD (P = 0.01) in adjusted models, with 1.7% more hip decline on ART than men (P = 0.001). Serum phosphate was positively associated with baseline spine BMD in women (P = 0.03) but not men, and area under the curve of fractional excretion of phosphate was negatively associated with spine BMD changes, particularly in women randomized to TDF regimens (P = 0.03 and 0.054 for interactions by sex, and randomization to TDF vs. non-TDF regimens, respectively; n = 44 women, 326 men). Women also had 0.6% (P = 0.004) more hip BMD decline than men associated with each 100 CD4 cells/μl increase on ART (P = 0.02; n = 49 women, 379 men). CONCLUSION: Women randomized to TDF-containing ART had accentuated spine loss associated with phosphaturia, and accentuated hip loss associated with CD4 restoration, regardless of TDF exposure. Viral load suppression reduced bone loss.en-USPublisher PolicyAbsorptiometry, PhotonAnti-Retroviral AgentsAntiretroviral Therapy, Highly ActiveBone Diseases, MetabolicCD4 Lymphocyte CountHIV InfectionsHypophosphatemia, FamilialSustained Virologic ResponseArticle