Reduced Bone Mineral Density Among ART-Naive Male Patients with HIV in China

Abstract

Authors contributed equally aims: To evaluate the prevalence and associated factors of reduced bone mineral density (BMD) among antiretroviral therapy (ART) naive HIV-infected male patients in China. Methods: We compared BMD between HIV-infected male patients and healthy controls. Risk factors of reduced BMD were studied using multivariable linear regression. Results: Reduced BMD rate of chronic HIV infection patients was higher. HIV infection was independently associated with decreased BMD after adjusting for demographic factors. Older age, lower BMI and men who have sex with men (MSM) were revealed as the risk factors of lower BMD in HIV-infected male patients. conclusion: Reduced BMD rate of HIV-infected patients was high. Policies are needed for prevention and treatment. KeywordsWidespread use of antiretroviral therapy (ART) has declined HIV-related morbidity and mortality dramatically in both resource-rich and resource-poor areas of the world [1,2]. Concomitantly, comorbidities including metabolic bone disorders are now seen commonly in HIV-infected patients [3]. Reduced bone mineral density (BMD) is a kind of systemic bone diseases characterized by low bone mass, bone microstructure damage and prone to fractures, and is prevalent in HIV-infected subjects [4,5]. Low BMD will increase the risk of fractures, diminish the quality of life, as well as increase the economic burden of the patients and society. Understanding the pathogenesis and risk factors of reduced BMD in HIV patients is urgent for proposing targeted approaches to fracture prevention in this high-risk population.Although the pathogenesis underlying this kind of bone loss is not completely understood, decreased BMD in HIV-infected population are most likely of multifactorial origins. Apart from traditional risk factors such as old age, female and low BMI, direct effect of ART might contribute [5,6]. Moreover, baseline CD4 + T-cell count was significantly associated with bone loss after ART initiation demonstrating pretreatment immunodeficiency had an effect on bone disorders [7]. Recently, the effect of HIV itself has been proposed as a contributor [8,9]. The prevalence of reduced BMD in ART-naive HIV-infected patients was higher than that of the healthy people [9,10]. This suggests that HIV infection may influence BMD regardless of ART status. Furthermore, half of a cohort of untreated acute HIV infection (AHI) men had reduced BMD, demonstrating that bone loss may occur very early [11].BMD assessment in HIV patients is sparsely done in resource-limited setting of China. To date, the condition of bone health among ART-naive HIV-infected patients in China has not For reprint orders, please contact: reprints@futuremedicine.com

Bone Mineral Density in Antiretroviral Therapy‐Naïve HIV‐1–Infected Young Adult ‐Women Using Depot Medroxyprogesterone Acetate or Nonhormonal Contraceptives in Uganda

“…The above findings are consistent with the majority of published studies that have reported HIV‐1 to be an independent risk factor for low BMD ( 33‐37 ) and can be explained by the direct effect of the HIV‐1 virus, as well as chronic immune activation. In untreated HIV‐1, through direct viral effects and inflammatory effects, bone resorption and bone formation are uncoupled.…”

Bone health and HIV in resource-limited settings

“…1 ). Data from both low-income countries such as Uganda [ 45 ▪ ], Nigeria [ 47 ▪ ], India [ 46 ], Indonesia [ 48 ] and middle-income countries (South Africa [ 49 ], Brazil [ 27 ], Turkey [ 50 ], China [ 51 , 52 ], Israel [ 53 ], and Thailand [ 54 ]) as well as mixed settings (South Africa, India, Thailand, Malaysia, and Argentina [ 55 ]) show varying levels of low BMD with some studies reporting a high prevalence of low BMD in HIV-positive individuals of up to 85% [ 53 ]. However, a few authors such as Hamill et al [ 49 ] from South Africa have reported comparable BMD levels between HIV-infected women and appropriate uninfected controls regardless of disease severity.…”