Bone Density Clinical Trial
Official title:
Vitamin D and Calcium Supplement Attenuate Bone Loss Among HIV- Infected Patients Receiving Tenofovir Disoproxil Fumarate, Lamivudine or Emtricitabine and Efavirenz: An Open-label, Randomized Controlled Trial
The purpose of this study is to determine whether calcium and vitamin D supplement can attenuate bone loss in HIV-infected-patients in Thailand who receive Tenofovir disoproxil fumarate.
Early initiation of antiretroviral therapy (ART) has transformed HIV infection into chronic
manageable disease. Although incidence of AIDS-related mortality has decreased, it has
increased for other co-morbid conditions including decrease bone mass, osteoporosis,
fragility fracture. There are multi-factorial that contribute to bone loss in HIV-infected
individuals including HIV virus itself that shift bone remodeling pathway toward bone
resorption, lifestyle and behavioral factors, co-morbid conditions and ART.
Initiation of ART is associated with 2%-6% reduction in bone mineral density during the
first 2 years of treatment regardless of ART regimens and then stabilization thereafter in
the majority of the study. This magnitude of bone loss is similar to postmenopausal women
during the first year.
Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue reverse transcriptase
inhibitor, has been associated with greater bone loss than other reverse transcriptase
inhibitors, that is recommended as the first line treatment in Thailand. Nonetheless there
is an evidence in western country that calcium and vitamin D supplement can attenuate bone
loss in naive HIV-infected individual who start ART with TDF. Even though many experts
recommend to avoid TDF and prefer abacavir, NRTIs which affect bone loss less than other
NRTIs, in high fracture risk patients, more than less HIV-infected-patients can access to
abacavir in resource limiting country. This research aims to study bone mineral density
(BMD) in HIV infected-patient in Thai population who receive tenofovir with calcium and
vitamin D supplement.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Prevention
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