French investigators conduct observational study of bone status in HIV-infected patients

Lucie Lemeunier, MD, of Tourcoing Hospital, Tourcoing, France, and colleagues conducted an observational study of bone status in HIV-infected patients. A decrease in bone mineral density (BMD) has been suggested as a consequence of antiretroviral therapy.

Theirs was a monocentric study conducted between March 2005 and July 2011, including 199 patients (148 men and 51 women), age 46.8 +/-11.3, who had a DEXA assessment at three sites (femoral neck, total hip, and lumbar spine) as part of their follow up. They noted BMD, osteoporosis risk factors, co-infection with VHC, CD4 rate, viral load, vitamin D status, ART, and cumulative duration of treatment.

The researchers recorded that 22% of men and 16% of women had osteoporosis, while 47% of men and 39% of women had osteopenia. Older age (P <0.01), and a lower BMI (P <0.001) were noteworthy in osteoporotic patients. No difference was found concerning smoking and alcohol habits, VHC coinfection, duration of HIV infection, CD4 rate, viral load, lipodystrophy, history of fracture, duration of exposure to each ART class, or vitamin D status. Femoral neck BMD was significantly associated with age, BMI, and NRTI treatment duration (without tenofovir) in simple regression analysis. 

Further, BMI was significantly associated with the total hip and lumbar spine BMD. Multiple regression analysis showed that age and BMI explained 20.8% of BMD variability at the femoral neck (P <0.001), BMI by itself 10.1% of BMD variability at the total hip (P <0.001) and finally, BMI and the duration of treatment with tenofovir was associated with 7.1% of BMD variability at the spine (P <0.001). The investigators found that CD4 rate was significantly lower in patients with a history of fractures (n=30; 15%) after adjustment for age and BMI (P=0.031). The prevalence of vitamin D insufficiency was high, with 24% of the patients with 25 OH vitamin D <10ng/mL and 65% between 10 and 30 ng/mL.