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Presentation by Andrew Carr.
Bone loss in 1st year of ART is a well established fact.
Loss is more on tenofovir containing regimes 2.4-3.8% non tenofovir 0.7-2.5%.
Compare to 1 year 10mg prednisolone 0.8 -3% loss
4RTC's show 0.5-1.5% loss BMD over 12-30 months!
Reversible if stopped after 1 year
Reversibility not established for longer periods, prep may be long term
Proportion of those with greater bone is uncertain
>3% loss at hip and LSS in 25-50%
Non adherence issues in early RCTs , so bone loss may be underestimated.
Study 36 men taking TDF-FTC PrEP on prelude trialNSW,av age 38, av weight 79.9,TDF exposure pretrial 6months.
Average BMD loss - 2.2 spine,-2.5 fem neck,but,approx 45% lost>3%, 25% lost>5% BMD
Study limitations :no control,no women,some loss attribuible to age, 1 year data only,no PK data
Longer f/up, data on secondary causes of BMD loss,more patients to identify risks for the greater loss group