Columbia University Medical Center, New York, NY 10032, USA.
AIDS. 2010 Nov 13;24(17):2679-86. doi: 10.1097/QAD.0b013e32833f6294.
The clinical importance of the association of HIV infection and antiretroviral therapy (ART) with low bone mineral density (BMD) in premenopausal women is uncertain because BMD stabilizes on established ART and fracture data are limited.
We measured time to first new fracture at any site with median follow-up of 5.4 years in 2391 (1728 HIV-infected, 663 HIV-uninfected) participants in the Women's Interagency HIV Study (WIHS). Self-report of fracture was recorded at semiannual visits. Proportional hazard models assessed predictors of incident fracture.
At baseline, HIV-infected women were older (40 ± 9 vs. 36 ± 10 years, P < 0.0001), more likely to report postmenopausal status and be hepatitis C virus-infected, and weighed less than HIV-uninfected women. Among HIV-infected women, mean CD4(+) cell count was 482 cells/μl; 66% were taking ART. Unadjusted incidence of fracture did not differ between HIV-infected and uninfected women (1.8 vs. 1.4/100 person-years, respectively, P = 0.18). In multivariate models, white (vs. African-American) race, hepatitis C virus infection, and higher serum creatinine, but not HIV serostatus, were statistically significant predictors of incident fracture. Among HIV-infected women, older age, white race, current cigarette use, and history of AIDS-defining illness were associated with incidence of new fracture.
Among predominantly premenopausal women, there was little difference in fracture incidence rates by HIV status, rather traditional risk factors were important predictors. Further research is necessary to characterize fracture risk in HIV-infected women during and after the menopausal transition.
HIV 感染和抗逆转录病毒治疗（ART）与绝经前妇女低骨密度（BMD）相关的临床重要性尚不确定，因为 BMD 在既定的 ART 治疗下会稳定，且骨折数据有限。
我们在妇女艾滋病研究机构（WIHS）中，对 2391 名参与者（1728 名 HIV 感染，663 名 HIV 未感染）进行了中位随访时间为 5.4 年的首次新发任何部位骨折的时间分析。骨折情况通过半年一次的就诊时的自我报告来记录。比例风险模型评估了骨折事件的预测因素。
在基线时，HIV 感染的女性年龄更大（40±9 岁 vs. 36±10 岁，P＜0.0001），更有可能报告绝经后状态和丙型肝炎病毒感染，且体重低于 HIV 未感染的女性。在 HIV 感染的女性中，平均 CD4+细胞计数为 482 个/μl；66%正在接受 ART 治疗。未调整的骨折发生率在 HIV 感染和未感染的女性之间没有差异（分别为 1.8/100 人年和 1.4/100 人年，P=0.18）。在多变量模型中，白种人（vs. 非裔美国人）种族、丙型肝炎病毒感染以及更高的血清肌酐，但不是 HIV 血清学状态，是骨折发生的统计学显著预测因素。在 HIV 感染的女性中，年龄较大、白种人、当前吸烟和艾滋病定义性疾病史与新发骨折的发生有关。
在以绝经前女性为主的人群中，HIV 状态与骨折发生率差异不大，而传统的危险因素是重要的预测因素。有必要进一步研究以描述 HIV 感染女性在绝经过渡期间和之后的骨折风险。
