Das Satyajit, Bopitya Shyamalie, Taha Huda, David Loay
Department of HIV & GU Medicine, Coventry & Warwickshire Partnership Trust, Coventry, UK.
Recent Pat Antiinfect Drug Discov. 2014;9(1):6-13. doi: 10.2174/1574891x09666140609123138.
Vitamin D deficiency and abnormal bone mineral density (BMD) have been reported in HIV patients. We aimed to find out the effects of antiretroviral therapy (ART) on serum vitamin D, parathyroid hormone (PTH) levels, BMD changes and fragility fracture rates in HIV patients.
We collected information about baseline demography, risk factors for fracture, viral load (VL), CD4 count, serum 25-OH vitamin D (n=357), PTH (n=277), phosphate, ionised calcium, creatinine and BMD of spine and hip by DEXA scan (hologic, n=142). Statistical analysis used one-way ANOVA followed by Dunn's multiple comparison tests. Results Table 1: Total 357 patients, mean age 41.1 (+/- 11.9) years, 249 (66%) black African, 197(52%) females, baseline CD4 count 451 (+/- 184) cells/dl, VL 1.4 log (+/- 1.2) copies/ml, duration of ART 52 (+/- 35) months were included in the analysis. Serum vitamin D was 15.3 (+/- 11.0) ng/ml, PTH (intact) 5.5 (+/- 3.9) pmol/l, corrected calcium 2.13 (+/- 0.9), phosphate 1.0 (+/- 0.2) and creatinine was 73.4 (+/- 21.1) mmol/l. Ninety four (66%) patients had abnormal BMD (T-score of spine or hip or both ≤ 1.0). Vitamin D levels were deficient (< 30 ng/ml) in 297 (78.7%) and PTH was high (>4.1 pmol/l) in 177 (64.8%) patients. Of 91 (30.9%) patients who had vitamin D levels below 10.0 ng/mL, PTH was high in 70 (n=91, 76.9%) and abnormal BMD in 50 (n=61, 75.4%) patients. Thirteen patients (3.2%) had possible fragility fractures. Tenofovir (TDF) users had higher PTH (P=0.002) and lower BMD of spine (0.01) and hip (0.002) and efavirenz (EFV) users had lower vitamin D (0.01) levels. On multivariate analysis including all significant variables, female sex (OR 1.5 CI 1.3-5.9), age over 40 years (OR 1.2 CI 0.9-5.1) and TDF use (OR 1.9 CI 1.6-6.9) were associated with abnormal BMD of hip but not spine.
Female patients over 40 years old on tenofovir containing regimens may have increased risk of BMD loss from hip. Whether Vitamin D replacement will prevent further bone loss needs further work.
据报道，HIV患者存在维生素D缺乏和骨矿物质密度（BMD）异常的情况。我们旨在探究抗逆转录病毒疗法（ART）对HIV患者血清维生素D、甲状旁腺激素（PTH）水平、BMD变化及脆性骨折发生率的影响。
我们收集了关于基线人口统计学、骨折危险因素、病毒载量（VL）、CD4细胞计数、血清25-羟维生素D（n = 357）、PTH（n = 277）、磷酸盐、离子钙、肌酐以及通过双能X线吸收法扫描（Hologic，n = 142）测量的脊柱和髋部BMD的信息。统计分析采用单因素方差分析，随后进行邓恩多重比较检验。结果表1：总共357例患者，平均年龄41.1（±11.9）岁，249例（66%）为非洲黑人，197例（52%）为女性，基线CD4细胞计数为451（±184）个/微升，VL为1.4 log（±1.2）拷贝/毫升，ART疗程为52（±35）个月，纳入分析。血清维生素D为15.3（±11.0）纳克/毫升，PTH（完整）为5.5（±3.9）皮摩尔/升，校正钙为2.13（±0.9），磷酸盐为1.0（±0.2），肌酐为73.4（±21.1）微摩尔/升。94例（66%）患者BMD异常（脊柱或髋部或两者的T值≤1.0）。297例（78.7%）患者维生素D水平不足（<30纳克/毫升），177例（64.8%）患者PTH升高（>4.1皮摩尔/升）。在91例（30.9%）维生素D水平低于10.0纳克/毫升的患者中，70例（n = 91，76.9%）PTH升高，50例（n = 61，75.4%）患者BMD异常。13例患者（3.2%）发生了可能的脆性骨折。使用替诺福韦（TDF）的患者PTH较高（P = 0.002），脊柱BMD较低（0.01），髋部BMD较低（0.002），使用依非韦伦（EFV） 的患者维生素D水平较低（0.01）。在纳入所有显著变量的多因素分析中，女性（OR 1.5，CI 1.3 - 5.9）、40岁以上年龄（OR 1.2，CI 0.9 - 5.1）和使用TDF（OR 1.9，CI 1.6 - 6.9）与髋部BMD异常相关，但与脊柱无关。
接受含替诺福韦方案治疗的40岁以上女性患者髋部BMD丢失风险可能增加。维生素D补充是否能预防进一步的骨质流失需要进一步研究。
