Documento de consenso: Recomendaciones para el manejo de la enfermedad ósea metabólica en pacientes con virus de la inmunodeficiencia humana

Martínez, Estebán; Gimeno, Esteban Jódar; García, Rebeca Reyes; Carpintero, Pedro; Casado, José L.; Montes, Javier del Pino; Pedrol, Pere Domingo; Estrada, Vicente; Maalouf, J.; Negredo, Eugènia; Ocampo, Antonio; Muñóz-Torres, Manuel

doi:10.1016/j.eimc.2013.07.008

Cited by 8 publications

(1 citation statement)

References 64 publications

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“…These changes in PTH levels are particularly important because they regulate the production of pro-inflammatory cytokines such as IL-6 and TNF-α, which stimulate osteoclastogenesis and bone resorption and, at the nuclear factor kappa-B receptor binding site, encourage the formation of osteoclasts, thereby increasing bone turnover. 2 , 3 Among PLWHIV who have not yet been treated, an uncoupling is seen between bone formation and resorption, due to the action of the virus itself, or rather, the immune-mediated effects of HIV on the skeleton, generating varying degrees of osteopenia and osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Osteonecrosis of the femoral head in people living with HIV: anatomopathological description and p24 antigen test

Lima¹,

Oliveira²,

Carvalho³

et al. 2018

HIV

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ObjectiveTo examine the presence of HIV in bone tissue of people living with HIV (PLWHIV) with osteonecrosis of femoral head and describe clinical and anatomopathological findings.DesignThis is a case series which included 44 PLWHIV with osteonecrosis of femoral head who underwent total hip arthroplasty.MethodsClinical data were obtained through analysis of the patients’ medical records. Bone tissue obtained during total hip arthroplasty was retrieved and sent for conventional and immunohistochemical analysis. Monoclonal antibodies were used to mark the p24 (HIV), CD31 (vascular endothelial cells), CD68 (macrophages), and D240 (cells of the lymphatic endothelium) antigens.ResultsDyslipidemia was found in 48% of the patients and lipodystrophy in 31%. Histological analysis showed similar characteristics for the entire sample. Degeneration of joint cartilage was visualized with the presence of fissures and fibrillations, as well as subchondral sclerosis and necrosis of the subchondral cancellous bone tissue. Lymphoplasmocytic inflammatory reaction was observed, with the presence of macrophages containing a foamy, vacuolated cytoplasm, as well as the presence of ceroid pigment and occasional granulation tissue. The reaction with the monoclonal anti-p24 antibody was negative in the samples from all 44 PLWHIV undergoing hip arthroplasty. Reactions with the anti-CD31 and anti-D240 antibodies were negative. Staining with CD68 antibody confirmed that the cells visualized with foamy, vacuolated cytoplasm were macrophages.Conclusionp24 HIV antigen was not detected in the bone tissue of PLWHIV and osteonecrosis. The most frequent anatomopathological findings were extensive necrosis of bone tissue, large vacuoles filled with fat cells, inflammatory lymphoplasmocytic reaction with macrophages containing vacuolated cytoplasm, and the presence of ceroid pigment.

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Section: Introductionmentioning

confidence: 99%

Osteonecrosis of the femoral head in people living with HIV: anatomopathological description and p24 antigen test

Lima¹,

Oliveira²,

Carvalho³

et al. 2018

HIV

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Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50 years of age

Llop

Sifuentes

Bañón³

et al. 2018

Arch Osteoporos

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Effect of a monthly dose of calcidiol in improving vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients

Bañón¹,

Rosillo

Gómez

et al. 2014

Endocrine

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There are no data about the optimal supplementation therapy in HIV-infected patients with vitamin D (25OHD) deficiency. The aim of this study was to assess the effect of an oral monthly dose of 16,000 IU calcidiol. We performed a longitudinal cohort study of 365 HIV-infected patients (24 % females) was with sequential determinations of 25OHD, serum parathyroid hormone (PTH), calcium, and alkaline phosphatase. The efficacy and safety of supplementation in 123 patients were compared against dietary and sun exposure advice. Overall, mean baseline 25OHD levels were 19.1 ng/ml (IQR 12-23.6), 63 % of patients had 25OHD deficiency and 27 % secondary hyperparathyroidism. After a median time of 9.3 months (95.61 patients-year on-treatment), 25OHD levels increased in comparison with non-supplemented patients (+16.4 vs. +3.2 ng/ml; p < 0.01), decreasing the rate of 25OHD deficiency (from 84 to 24 %), and decreasing serum PTH (-4.9 pg/ml) and the rate of secondary hyperparathyroidism (from 43 to 31 %; p < 0.001). This improvement was observed irrespective of HIV/HCV coinfection or the use of efavirenz. In a regression analysis, adjusting by seasonality, a lower baseline 25OHD was associated with persistence of deficiency (relative risk, RR 1.07; 95 % CI 1.03-1.1; p < 0.001), whereas calcidiol supplementation was the only factor associated with significant improvement (RR 0.38; 95 % CI 0.12-0.46; p < 0.001). This monthly dose showed no clinical toxicity, and no patient had 25OHD levels above 100 ng/ml, nor hypercalcemia. The use of monthly calcidiol is safe, easy to take, and largely effective to improve vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients.

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Documento de consenso: Recomendaciones para el manejo de la enfermedad ósea metabólica en pacientes con virus de la inmunodeficiencia humana

Cited by 8 publications

References 64 publications

Osteonecrosis of the femoral head in people living with HIV: anatomopathological description and p24 antigen test

Osteonecrosis of the femoral head in people living with HIV: anatomopathological description and p24 antigen test

Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50 years of age

Effect of a monthly dose of calcidiol in improving vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients

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