Prevalence and predictors of low bone mineral density in treatment-naive HIV-infected patients and its correlation with CD4 cell counts

Abstract

Objective: HIV virtually affects every organ system of the body. The skeletal system is no exception, and antiretroviral therapy (ART) has been implicated in bone diseases. However, not many studies have been done to evaluate bone disease in treatment (ART) naive HIV-infected patients, and hence, the present study was executed. Materials and Methods: One hundred and twenty HIV-infected ART-naive patients and 80 age- and sex-matched healthy controls were recruited for this study. A thorough history and physical examination was done followed by laboratory investigations after an overnight fasting. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry scan at the level of lumbar spine, femur, and forearm. Results: Of 120 ART-naive HIV-infected cases, the prevalence of osteoporosis and osteopenia was 13% and 41%, respectively, as compared to 0% and 17.5% in controls ( P < 0.001). The mean BMD in cases was 0.842 g/cm 2 which was approximately 25% lesser than that in controls. Hypovitaminosis-D was seen in 100% of cases as compared to 65% of controls ( P < 0.01). A significant association of low BMD was seen with HIV-infection per se ( P < 0.001), low CD4 cell counts ( P < 0.001), low Vitamin D levels ( P < 0.001), long duration of disease ( P < 0.04), history of opportunistic infections ( P < 0.03), and history of tuberculosis in the past ( P < 0.05). Conclusion: Bone diseases such as osteoporosis and osteopenia characterized by low BMD are very common in HIV-infected patients. Virus per se , along with low CD4 cell counts and low Vitamin D levels are major predictors of pathological fractures in these individuals.

Impact of biomechanical loading on bone mineral density explored in weight-bearing and non-weight-bearing bones of people living with HIV: An observational study

“…Achieving immunologic reconstitution over a period of time implies minimizing the negative impact of HIV on BMD as already discussed above [6,[11][12][13][14][15][16][17][18][19][20][21][22]. Since the males were on HAART for a longer period of 4 years compared to 3 years recorded in the females, they should have a better immunologic reconstitution than the females.…”

“…HIV infection directly alters bone metabolism (and by extension the bone structure) through its immune-depressive effects, and by stimulating the release of inflammatory mediators such as cytokines, resulting in reduced bone mineral density (BMD) and bone mass [11,12,[13][14][15][16][17][18][19][20][21][22]. This action in the absence of an opposing anti-inflammatory response will distort bone homeostasis [23].…”

Impact of weight-bearing and sex-stratified differences in risk factors of bone loss on bone mineral density in HIV conditions – findings of the Nigeria HIV-BMD study: An observational study

“…For instance, a high baseline BMI had independently improved 30-month T lymphocytes (CD4+) recovery implying that a higher BMI could determine better immune reconstitution in PLWH after commencing HAART [76]. Achieving immunologic reconstitution with time implies minimizing the negative impact of HIV on BMD as already discussed above [6,[11][12][13][14][15][16][17][18][19][20][21][22]. Since the males were on HAART for a longer period of 4 years compared to 3 years recorded in the females, they should have a better immunologic reconstitution than the females hence the consequent significant positive impact of HAART duration on their BMD.…”

“…HIV infection directly alters bone metabolism (and by extension the bone structure) through its immune-depressive effects, and by stimulating the release of inflammatory mediators such as cytokines, resulting in reduced bone mineral density (BMD) and bone mass [11,12,[13][14][15][16][17][18][19][20][21][22]. This action in the absence of an opposing anti-inflammatory response will distort bone homeostasis [23].…”

Risk of Fractures in Older Adults Living with HIV

“…This loss of bone mineral density is because of the own virus's proinfl ammatory cytokines just as the damage to the immunologic system. It is seen that the CD4 <50 cell/mm^3 count [20] and AIDS-defi ning illnesses have increased the fracture rate due to a loss of bone mineral density [10].…”