Evaluation of initial results of naïve HIV-infected patients regarding bone health

Authors

Keywords:

HIV, DEXA, Bone mineral density, Serum calcium, 25 (OH) vitamin D

Abstract

Aim: HIV-infected patients have increased risk of osteoporosis due to both HIV and the treatment regimens in HIV. Our aim was to reveal the need of screening for bone health in HIV-infected patients, and to reveal the relationship between indirect serum markers of bone-condition, CD4+ T lymphocyte counts and HIV RNA viral loads and DEXA screening results.

Methods: Naïve HIV positive patients over 18 years old who were under follow-up in our hospital between January 2014 and December 2018  were included in this retrospective cohort study. CD4+ T cell counts, HIV RNA viral loads, body mass indexes (BMI), 25 (OH) vitamin D, serum calcium and corrected calcium (cCa) levels and DEXA screening results of these patients were recorded. For statistical analysis and interpretation, e-picos (https://www.e-picos.com) and SPSS (version 20.0; SPSS Inc., Chicago, IL, USA) were used.

Results: A total of 101 naive HIV-infected patients were included in the study. Vitamin D levels were within normal limits in only 9 (10.8%) patients, while 42 (50.6%) patients had insufficiency and 32 (38.5%) patients had deficiency. Serum calcium and cCa values were significantly lower in patients with < 40 years of age (P=0.04). According to the T-score assessment in DEXA screening, 19 patients (47.5%) had osteopenia findings in at least one of three regions (femoral neck, total hip and lumbar spine). A total of three male patients (7.5%) had osteoporosis. In terms of viral load, only BMD and T-score in women with viral load > 100,000 IU/mL were significantly lower in lumbar spine (P=0.01 and P=0.01, respectively). In terms of CD4 counts, only Z-scores in only lumbar spine and femoral neck were statistically lower in women with CD4 counts > 200 cells/µl (P=0.04 and P=0.03, respectively). There were not any significant differences in any other groups and region in terms of viral load and CD4 count. None of the factors including high viral load, low CD4 + count, low 25 (OH) vitamin D level or low cCa levels were directly related to T, Z-score and low BMD.

Conclusion: Osteopenia and osteoporosis are observed more frequently and at younger ages in HIV-infected patients than in the general population. Since we cannot make any prediction on bone health using one of the indirect markers in serum including 25 (OH) vitamin D levels and Ca levels or viral loads and CD4 counts in HIV-infected patients, BMD screening at younger ages may be beneficial.

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References

Kruger MJ, Nell TA. Bone mineral density in people living with HIV: a narrative review of the literature. AIDS Res Ther. 2017;14(1):35.

Young B, Dao CN, Buchacz K, Baker R, Brooks JT, Investigators HIVOS. Increased rates of bone fracture among HIV-infected persons in the HIV Outpatient Study (HOPS) compared with the US general population, 2000-2006. Clin Infect Dis. 2011;52(8):1061-8.

Womack JA, Goulet JL, Gibert C, Brandt C, Chang CC, Gulanski B, et al. Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS One. 2011;6(2):e17217.

Cotter AG, Sabin CA, Simelane S, Macken A, Kavanagh E, Brady JJ, et al. Relative contribution of HIV infection, demographics and body mass index to bone mineral density. AIDS. 2014;28(14):2051-60.

Bedimo R, Cutrell J, Zhang S, Drechsler H, Gao A, Brown G, et al. Mechanisms of bone disease in HIV and hepatitis C virus: impact of bone turnover, tenofovir exposure, sex steroids and severity of liver disease. AIDS. 2016;30(4):601-8.

Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E. FRAX and its applications to clinical practice. Bone. 2009;44(5):734-43.

Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368-81.

Fatma Gumuser FA. Osteopenia/Osteoporosis and Vitamine D Levels in Our Group of Male HIV Positive Patients. Flora. 2019;24(1):52-62.

Aydın OA, Karaosmanoglu HK, Karahasanoglu R, Tahmaz M, Nazlıcan O. Prevalence and risk factors of osteopenia/osteoporosis in Turkish HIV/AIDS patients. The Brazilian Journal of Infectious Diseases. 2013;17(6):707-11.

Vlot MC, Grijsen ML, Prins JM, de Jongh RT, de Jonge R, den Heijer M, et al. Effect of antiretroviral therapy on bone turnover and bone mineral density in men with primary HIV-1 infection. PLoS One. 2018;13(3):e0193679.

Tükenmez-Tigen E, Korten V. HIV İnfeksiyonu ve Antiretroviral Tedavinin Osteopeni Gelişimine Etkileri. Klimik Journal/Klimik Dergisi. 2012;25(2).

Bang UC, Shakar SA, Hitz MF, Jespersen MS, Andersen O, Nielsen SD, et al. Deficiency of 25-hydroxyvitamin D in male HIV-positive patients: a descriptive cross-sectional study. Scandinavian journal of infectious diseases. 2010;42(4):306-10.

Dao CN, Patel P, Overton ET, Rhame F, Pals SL, Johnson C, et al. Low vitamin D among HIV-infected adults: prevalence of and risk factors for low vitamin D Levels in a cohort of HIV-infected adults and comparison to prevalence among adults in the US general population. Clinical Infectious Diseases. 2011;52(3):396-405.

Gedela K, Edwards SG, Benn P, Grant AD. Prevalence of vitamin D deficiency in HIV-positive, antiretroviral treatment-naïve patients in a single centre study. International journal of STD & AIDS. 2014;25(7):488-92.

Juliana Maria Palmeira Canuto VMPC, Matheus Henrique Alves de Lima, Ana Luiza Costa Silva de Omena, Thayná Melo de Lima Morais, Arthur Maia Paiva, Erik Trovão Diniz, David Joseph Ferreira Tenório de Almeida, Sonia Maria Soares Ferreira. Risk factors associated with hypovitaminosis D in HIV/aids-infected adults Arch Endocrinol Metab 2015;2015(59/1):34-41.

Sharma. EYS. Physiology, Calcium: StatPearls Publishing LLC.; 2019.

Cotter EJ, Malizia AP, Chew N, Powderly WG, Doran PP. HIV proteins regulate bone marker secretion and transcription factor activity in cultured human osteoblasts with consequent potential implications for osteoblast function and development. AIDS research and human retroviruses. 2007;23(12):1521-30.

Walker Harris V, Brown TT. Bone loss in the HIV-infected patient: evidence, clinical implications, and treatment strategies. Journal of Infectious Diseases. 2012;205(suppl_3):S391-S8.

Bonjoch A, Figueras M, Estany C, Perez-Alvarez N, Rosales J, del Rio L, et al. High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study. Aids. 2010;24(18):2827-33.

Grijsen ML, Vrouenraets SM, Steingrover R, Lips P, Reiss P, Wit FW, et al. High prevalence of reduced bone mineral density in primary HIV-1-infected men. Aids. 2010;24(14):2233-8.

Rochira V, Zirilli L, Orlando G, Santi D, Brigante G, Diazzi C, et al. Premature decline of serum total testosterone in HIV-infected men in the HAART-era. PloS one. 2011;6(12):e28512.

Short C-ES, Shaw SG, Fisher MJ, Walker-Bone K, Gilleece YC. Prevalence of and risk factors for osteoporosis and fracture among a male HIV-infected population in the UK. International journal of STD & AIDS. 2014;25(2):113-21.

Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. Aids. 2006;20(17):2165-74.

Santi D, Madeo B, Carli F, Zona S, Brigante G, Vescini F, et al. Serum total estradiol, but not testosterone is associated with reduced bone mineral density (BMD) in HIV-infected men: a cross-sectional, observational study. Osteoporosis International. 2016;27(3):1103-14.

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Published

2019-05-28

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Research Article

How to Cite

1.
Yenilmez E, Çetinkaya RA. Evaluation of initial results of naïve HIV-infected patients regarding bone health. J Surg Med [Internet]. 2019 May 28 [cited 2022 Dec. 7];3(5):384-9. Available from: https://jsurgmed.com/article/view/566996