BMD Is Reduced in HIV-Infected Men Irrespective of Treatment

AIDS, 2003

Objective: To describe the alterations in the bone metabolism of HIV-seropositive patients and evaluate the effects of antiretroviral therapies. Design: Cross-sectional analytical study. Method and materials: A total of 142 subjects (113 male, 29 female), aged 20-45 years were divided into four groups: group A, 33 HIV-seropositive antiretroviral-naive patients; group B1, 36 HIV-seropositive patients on antiviral therapy for over 1 year, without protease inhibitors (PI); group B2, 42 HIV-seropositive patients on combined therapy containing PI for over 1 year; and group C, 15 healthy, HIV-seronegative subjects. Bone mineral density (BMD) were determined by dual energy X-ray absorptiometry in total body, lumbar spine and proximal femur; and evaluation of serum osteocalcin, D-pyridinoline, parathyroid hormone (THP), calcium and phosphate, and urine calcium. Results: BMD was significantly lower in HIV-seropositive patients in comparison with healthy controls, in all sites studied. However, no statistical differences were observed among all groups of HIV-infected patients, independently of the antiretroviral therapy. There was a significantly higher occurrence of osteopenia and osteoporosis in HIVinfected patients in comparison with controls (P , 0.0001), with no differences among treatment-naive patients and either of the treatment groups. Bone formation and resorption markers were similar among all studied groups. There was a significant correlation in all bone sites between time of infection and BMD (P , 0.02). Conclusions: BMD was significantly lower in HIV-seropositive patients in comparison with controls in lumbar spine, proximal femur and total body, without significant differences among treatment-naive patients and either of the treatment groups. Only time with HIV infection and not specific therapy was associated with BMD decreases.

GERMS, 2016

Background Aging of persons with human immunodeficiency virus (HIV) resulted in high rates of osteopenia and osteoporosis. Multiple cohort studies have reported an increased prevalence of bone demineralization among HIV-infected individuals. The aim of this study was to evaluate bone mineral density (BMD) and risk factors for osteopenia/osteoporosis among HIV-positive patients attending the National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania. Methods We performed a cross-sectional study that enrolled 60 patients with HIV. The association between BMD and lifestyle habits (smoking), body mass index (BMI), nadir cluster of differentiation 4 (CD4) cell count, current CD4 cell count, HIV viral load and history of combination antiretroviral therapy (cART) were investigated. The BMD was measured at the lumbar spine, hips and total body using dual-energy X-ray absorptiometry (DEXA). Results In the present study, DEXA evaluation showed an overall prevalence of osteoporosis of 16.66% (ten patients) and a prevalence of osteopenia of 48.33% (29 patients). In men, low BMI and cigarette smoking showed significant association with the diagnosis of lumbar spine demineralization (p=0.034 and p=0.041, respectively). Duration of exposure to cART classes in relation to BMD was also evaluated. The use of non-nucleoside reverse-transcriptase inhibitors (NNRTIs) was associated with low lumbar spine BMD in all patients (p=0.015). Reduced BMD was significantly associated with protease inhibitors (PIs)-containing treatment (p=0.043) in women. Conclusion At lumbar spine DEXA, male gender was statistically associated with reduced BMD. At the left hip Ward's area, decreased BMD T scores were significantly associated with aging. The reduced BMD was higher in patients receiving PI-or NNRTI-containing regimens. Keywords HIV, bone mineral density, osteopenia, osteoporosis, antiretroviral therapy Background 1 Increased accessibility and widespread combination antiretroviral therapy (cART) resulted in significant improvement in life expectancy for most HIV-infected patients. But long term use of combination antiretroviral

AIDS research and human retroviruses, 2015

HIV-infected persons are living longer on combination antiretroviral therapy (cART) but experiencing more comorbidities including low bone mineral density (BMD). Using data from the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study), we determined the prevalence of low BMD (T-score below one standard deviation of the reference mean) and compared it with matched controls from the National Health and Nutrition Examination Survey (NHANES). We also assessed 4-year longitudinal BMD changes among participants virologically suppressed on cART. Of 653 participants included in this analysis (77% male, 29% black, median age 41 years, median CD4(+) cell count 464 cells/mm(3), 89% with HIV RNA <400 copies/ml), 51% and 10% had baseline osteopenia and osteoporosis, respectively. Low BMD at the femoral neck was significantly more prevalent than for the NHANES controls (47% versus 29%, p<0.001). Lower body mass index, nonwhite race, longer teno...

AIDS, 2010

To assess the bone mineral density (BMD) in a cohort of men with primary HIV-1 infection (PHI). methods Thirty-three men with PHI had a DXA of the lumbar spine, femoral neck and total hip. Osteopenia and osteoporosis were defined according to WHO criteria as T-scores between-1 and-2.5 and ≤-2.5, respectively. The association between clinical and laboratory parameters and BMD was investigated using multivariable linear regression analysis. Results Mean age was 38 (SD 9) years and mean body mass index (BMI) 22.7 (SD 3.3) kg/m 2. Twenty-four men (73%) had a negative or indeterminate Western blot, 32 men (97%) were cART naive. Mean plasma HIV-1 RNA was 5.0 (SD 1.2) log 10 copies/ml. Mean lumbar spine T (-0.8, SD 1.3, P=0.001) and Z-scores (-0.7, SD 1.3, P=0.004) and femoral neck T-score (-0.5, SD 0.9, P=0.003) were significantly lower compared to the reference population. 15/33 men (45%) had osteopenia and 2/33 (6%) osteoporosis. Markers of bone turnover did not differ between patients with or without osteopenia/ osteoporosis. Age was negatively associated with femoral neck (β-coefficient=-0.05;P<0.001) and total hip T-scores (β=-0.03;P=0.04). BMI was associated with lumbar spine (β=0.3), femoral neck (β=0.2) and total hip (β=0.2) T-scores (P<0.001) and thyroid stimulating hormone (TSH) with lumbar spine (β=0.5;P=0.045) and femoral neck T-scores (β=0.4;P=0.005). Increased plasma viral load was associated with lower total hip T-scores (β=-0.2;P=0.02). conclusions Reduced BMD was prevalent in PHI-men and was associated with increased age, lower BMI and TSH levels, and higher levels of HIV-1 viraemia.

The Journal of infectious diseases, 2016

We compared adjusted bone mineral density (BMD) changes between human immunodeficiency virus (HIV)-infected individuals during the first approximately 7.5 years after antiretroviral therapy (ART) initiation and HIV-uninfected controls. HIV-infected individuals (n = 97) had significantly greater adjusted BMD decline than controls (n = 614) during the first 96 weeks of ART. Subsequently, the rate of BMD decline slowed in HIV-infected individuals but remained greater than the rate of decline in HIV-uninfected individuals at the lumbar spine but not at the hip. In HIV-infected individuals after 96 weeks, no HIV- or treatment-related characteristic was associated with BMD loss, but lower lean body mass was associated with greater BMD loss at both lumbar spine and hip.

AIDS, 2010

AIDS, 2008

2018

The commencement of antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected individuals has decreased HIV-related complications and improved survival. However, studies have shown that there is a higher prevalence of osteopenia/osteoporosis [reduced bone mineral density (BMD)] in HIV-infected individuals. The aim of our study was to determine the prevalence of osteopenia/osteoporosis (reduced BMD), vitamin D level, the 10-year probability of fracture risk, and its associated risk factors in HIV-infected and HIV-uninfected individuals in Malaysia. HIV-infected individuals aged ≥25 years and virologically suppressed on ART for at least 1 year, were recruited from September 2014-September 2016, at a tertiary hospital in Malaysia. HIV-uninfected individuals were recruited from the community. BMD was assessed using dual X-ray absorptiometry (DXA), whilst the 10-year probability of fracture risk was calculated using the fracture risk assessment tool (FRAX ®). A total of 684 potential participants were approached; of which 640 participants agreed to participate (response rate=93.6%). Participants were then matched for gender and age, finally giving 206 participants in each group. The majority of participants were male (73.8%) and Chinese (64.1%) with the median age of 40 years old. A significantly higher number of HIV-infected individuals (73.8%) had reduced BMD when compared to HIV-uninfected individuals [(57.3%), p<0.001]. The prevalence of osteoporosis was found to be significantly higher in HIV-infected individuals (14.1%) when compared to HIV-uninfected individuals [(5.3%), p<0.001]. Similarly, vitamin D deficiency (<50nmol/L) was significantly higher in HIV-infected (65.0%) compared to uninfected individuals [(30.1%), p<0.001]. The 10-year probability of sustaining a hip U n i v e r s i t y o f M a l a y a v fracture in HIV-infected individuals (0.4%) was significantly higher than in HIVuninfected individuals (0.2%, p=0.003), but not in major osteoporotic fracture [HIVinfected (1.7%); HIV-uninfected (1.3%)] (p=0.066). Lower body mass index (BMI), reduced physical activity and older age were risk factors that significantly associated with reduced BMD in HIV-infected individuals. In conclusion, the prevalence of reduced BMD, vitamin D deficiency and the 10-year probability of sustaining a hip fracture was higher in HIV-infected compared to HIV-uninfected individuals. Lower BMI, reduced physical activity and older age were found to be associated with reduced BMD in HIVinfected individuals.

Bone, 2011

Antiretroviral therapy has decreased the rate of HIV-related mortality and extended the life span of HIV patients. Current guidelines recommend the use of a 3-drug regimen, such as two nucleoside reverse transcriptase inhibitors and a protease inhibitor, boosted by ritonavir. Osteoporosis can be associated with the HIV disease itself or with antiretroviral therapy. Many trials have been conducted employing a single drug regimen to simplify antiretroviral therapy but few studies assessed the effect of the single drug regimen on bone mineral density (BMD). The objectives of the study were to assess and compare the relative (%) changes in lumbar spine and hip BMD over 48 weeks in HIV patients treated with mono or triple antiretroviral regimens The study was conducted using data from a randomized trial (MONARK) conducted in 136 antiretroviralnaïve HIV patients (89 men and 47 women) comparing the antiviral efficacy of a single-drug protease inhibitor regimen of lopinavir/ritonavir (LPV/r) versus LPV/r in combination with zidovudine (ZDV) and lamivudine (3TC). Lumbar spine and total hip BMD were assessed in 100 patients by dual-energy X-ray absorptiometry at baseline and 48 weeks. 48 week-BMD data were available for 43 patients (mean age 37 years) with a mean baseline lumbar spine Zscore of −0.1 in the LPV/r monotherapy group and for 25 patients (mean age 35.8 years) with a mean baseline lumbar spine Z-score of −0.2 in the LPV/r + ZDV + 3TC group. After 48 weeks, lumbar spine BMD significantly decreased by 4.4% (− 5.1% to −2.1%, P ≤ 0.001) in the LPV/r group and by 4.0% (− 5.0% to −1.7%, P ≤ 0.0001) in the LPV/r + ZDV + 3TC group. There was no significant difference in BMD changes between the two groups. These results suggest that bone loss is observed 48 weeks after the initiation of antiretroviral therapy, whether the patients receive a single-or triple-drug antiretroviral regimen.

HIV Clinical Trials, 2003

The prevalence of osteopenia in HIV-infected patients is high. However, the mechanisms implicated in bone mass loss in HIV infection are unclear. Because of this, we analyzed serum free testosterone and vitamin D 3 hydroxylated metabolites in HIV-infected patients, with and without antiretroviral treatment, and the relation between them and osteopenia. Seventy-four HIV-infected patients were selected because they had frozen sera available at a date close to a DEXA evaluation. Free testosterone, 25(OH)D 3 , and 1,25(OH) 2 D 3 were determined in frozen serum. There were no differences in free testosterone, 25 OH)D 3 , and 1,25(OH) 2 D 3 levels between patients with and without osteopenia. 25(OH)D 3 levels in naive and HAART-treated patients were 26.2 (10.3-32.8) and 33.1 (20.6-46.8) ng/ml, respectively (p ‫؍‬ 0.04). 1,25(OH) 2 D 3 levels in naive and HAARTtreated patients were 60.3 (49.2-80.8) and 85.5 (68-111.6) pmol/liter (p ‫؍‬ 0.01). Free testosterone levels in 9 naive men and in 50 HAART-treated men were 42.6 (24.1-67.3) and 69.2 (47.5-112.1) pmol/liter, respectively (p ‫؍‬ 0.04). In conclusion, HIV-infected patients with and without osteopenia showed similar levels of vitamin D metabolites and free testosterone. However, antiretroviral drug-naive patients showed lower serum levels of vitamin D metabolites and free testosterone than HAART-treated patients.