Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project

Bone mineral density (BMD) declines due to tenofovir-containing pre-exposure prophylaxis (PrEP) have varied among PrEP demonstration projects, potentially related to variable adherence. Characterization of BMD changes in highly adherent individuals, estimated via tenofovir-diphosphate (TFV-DP) level...

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Main Authors: Matthew A. Spinelli, David V. Glidden, Peter L. Anderson, Monica Gandhi, Vanessa M. McMahan, Patricia Defechereux, Mauro Schechter, Valdiléa G. Veloso, Suwat Chariyalertsak, Juan V. Guanira, Linda Gail Bekker, Susan P. Buchbinder, Robert M. Grant
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Published: 2019
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/66679
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spelling th-cmuir.6653943832-666792019-09-16T12:56:06Z Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project Matthew A. Spinelli David V. Glidden Peter L. Anderson Monica Gandhi Vanessa M. McMahan Patricia Defechereux Mauro Schechter Valdiléa G. Veloso Suwat Chariyalertsak Juan V. Guanira Linda Gail Bekker Susan P. Buchbinder Robert M. Grant Immunology and Microbiology Medicine Bone mineral density (BMD) declines due to tenofovir-containing pre-exposure prophylaxis (PrEP) have varied among PrEP demonstration projects, potentially related to variable adherence. Characterization of BMD changes in highly adherent individuals, estimated via tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS), can assist clinicians when counseling patients. Cisgender men who have sex with men and transwomen in the optional dual-energy X-ray absorptiometry (DXA) substudy of a large, international, open-label PrEP demonstration project, the iPrEx-open-label extension (OLE) study underwent DXA scans and DBS collection every 24 weeks, with average weekly dosing adherence patterns (2, 4, and 7 doses/week) estimated from validated TFV-DP cut-offs. The mean percent BMD change was estimated in strata of average weekly adherence by using a linear mixed-effects model to calculate the BMD decline in highly adherent individuals on PrEP for the first time. DXA/DBS data were available for 254 individuals over a median of 24 weeks in iPrEx-OLE from June 2011 to December 2013. The percent decline in spine BMD was monotonically associated with strata of increasing average weekly adherence (p < .001 trend); the p value for trends using hip BMD measurements was .07. Individuals with estimated daily adherence experienced a 1.2% decrease in spine BMD and a 0.5% drop in hip BMD. In highly adherent PrEP users, we found a lower-than-expected drop in BMD when compared with previous studies. This drop is likely not clinically significant for most PrEP users. However, for those at the highest risk of fracture who plan prolonged PrEP use, alternate PrEP strategies could be considered. 2019-09-16T12:53:35Z 2019-09-16T12:53:35Z 2019-09-01 Journal 19318405 2-s2.0-85071997499 10.1089/AID.2018.0297 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85071997499&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/66679
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Immunology and Microbiology
Medicine
spellingShingle Immunology and Microbiology
Medicine
Matthew A. Spinelli
David V. Glidden
Peter L. Anderson
Monica Gandhi
Vanessa M. McMahan
Patricia Defechereux
Mauro Schechter
Valdiléa G. Veloso
Suwat Chariyalertsak
Juan V. Guanira
Linda Gail Bekker
Susan P. Buchbinder
Robert M. Grant
Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project
description Bone mineral density (BMD) declines due to tenofovir-containing pre-exposure prophylaxis (PrEP) have varied among PrEP demonstration projects, potentially related to variable adherence. Characterization of BMD changes in highly adherent individuals, estimated via tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS), can assist clinicians when counseling patients. Cisgender men who have sex with men and transwomen in the optional dual-energy X-ray absorptiometry (DXA) substudy of a large, international, open-label PrEP demonstration project, the iPrEx-open-label extension (OLE) study underwent DXA scans and DBS collection every 24 weeks, with average weekly dosing adherence patterns (2, 4, and 7 doses/week) estimated from validated TFV-DP cut-offs. The mean percent BMD change was estimated in strata of average weekly adherence by using a linear mixed-effects model to calculate the BMD decline in highly adherent individuals on PrEP for the first time. DXA/DBS data were available for 254 individuals over a median of 24 weeks in iPrEx-OLE from June 2011 to December 2013. The percent decline in spine BMD was monotonically associated with strata of increasing average weekly adherence (p < .001 trend); the p value for trends using hip BMD measurements was .07. Individuals with estimated daily adherence experienced a 1.2% decrease in spine BMD and a 0.5% drop in hip BMD. In highly adherent PrEP users, we found a lower-than-expected drop in BMD when compared with previous studies. This drop is likely not clinically significant for most PrEP users. However, for those at the highest risk of fracture who plan prolonged PrEP use, alternate PrEP strategies could be considered.
format Journal
author Matthew A. Spinelli
David V. Glidden
Peter L. Anderson
Monica Gandhi
Vanessa M. McMahan
Patricia Defechereux
Mauro Schechter
Valdiléa G. Veloso
Suwat Chariyalertsak
Juan V. Guanira
Linda Gail Bekker
Susan P. Buchbinder
Robert M. Grant
author_facet Matthew A. Spinelli
David V. Glidden
Peter L. Anderson
Monica Gandhi
Vanessa M. McMahan
Patricia Defechereux
Mauro Schechter
Valdiléa G. Veloso
Suwat Chariyalertsak
Juan V. Guanira
Linda Gail Bekker
Susan P. Buchbinder
Robert M. Grant
author_sort Matthew A. Spinelli
title Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project
title_short Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project
title_full Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project
title_fullStr Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project
title_full_unstemmed Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project
title_sort impact of estimated pre-exposure prophylaxis (prep) adherence patterns on bone mineral density in a large prep demonstration project
publishDate 2019
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85071997499&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/66679
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