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Keywords:

  • HIV;
  • osteoporosis;
  • fractures;
  • bone resorption;
  • bone formation;
  • treatment

Abstract

Osteoporosis has be reported to be a complication of active antiretroviral therapy of HIV infection. We studied 148 HIV-infected men stratified according to their treatment. Our data show that these patients have an average 9% decreased BMD, irrespective of their treatment. Low body mass index and high resorption markers were associated with low bone density.

Introduction: Osteoporosis has been reported in HIV-infected (HIV+) patients, and it has been suggested that it may be linked to protease-inhibitor treatments (PI).

Materials and Methods: To assess this risk and to investigate its putative link with treatments, we compared the bone density of HIV+ men, who were either receiving treatment (including PI [PI+], n = 49; without PI [PI], n = 51) or untreated (UT, n = 48). We included 81 age-matched control HIV-negative (HIV) males (age, 40 ± 8 years).

Results: BMD adjusted for age (Z-score) was lower in the HIV+ patients at the lumbar spine (HIV+: −1.08 ± 1.21, HIV: −0.06 ± 1.26, p < 0.001) and the femoral neck (HIV+: −0.39 ± 1.05, HIV: 0.25 ± 0.87, p < 0.001). The prevalence of osteoporosis was 16% in HIV+ and 4% in HIV subjects (p < 0.01). In the HIV+ subjects, the Z-score was correlated only to body mass index (r = 0.27 at lumbar spine and 0.35 at femoral neck). Untreated HIV+ patients had a negative Z-score (−0.82 ± 1.15 for the lumbar spine), which was not different from the one of treated HIV+ patients. In the PI+ and PI groups, the Z-score did not depend on the presence of lipodystrophy or the proportion of fat in the abdomen and legs measured by DXA. Markers of bone remodeling were measured in the 132 HIV+ and 35 HIV subjects. Compared with controls, HIV+ patients had lower bone alkaline phosphatase and higher urinary cross-laps/Cr, which was negatively correlated with the Z-score at both the femoral neck (r = −0.22) and lumbar spine (r = −0.21). TNFα was increased in untreated compared with treated HIV+ subjects and was not correlated to the Z-score.

Conclusion: Our cross-sectional study does not show any deleterious effect of the treatment but does indicate a decrease in bone density in HIV+ patients irrespective of the treatment. This low bone density is in part related to the low body weight and is associated with increased bone resorption.