Kooij Katherine W, Wit Ferdinand W N M, Bisschop Peter H, Schouten Judith, Stolte Ineke G, Prins Maria, van der Valk Marc, Prins Jan M, van Eck-Smit Berthe L F, Lips Paul, Reiss Peter
Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development.
Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA).
J Infect Dis. 2015 Feb 15;211(4):539-48. doi: 10.1093/infdis/jiu499. Epub 2014 Sep 1.
Human immunodeficiency virus (HIV) and combination antiretroviral therapy (cART) may both contribute to the higher prevalence of osteoporosis and osteopenia in HIV-infected individuals.
Using dual-energy X-ray absorptiometry, we compared lumbar spine, total hip, and femoral neck bone mineral density (BMD) in 581 HIV-positive (94.7% receiving cART) and 520 HIV-negative participants of the AGEhIV Cohort Study, aged ≥45 years. We used multivariable linear regression to investigate independent associations between HIV, HIV disease characteristics, ART, and BMD.
The study population largely consisted of men who have sex with men (MSM). Osteoporosis was significantly more prevalent in those with HIV infection (13.3% vs 6.7%; P<.001). After adjustment for body weight and smoking, being HIV-positive was no longer independently associated with BMD. Low body weight was more strongly negatively associated with BMD in HIV-positive persons with a history of a Centers for Disease Control and Prevention class B or C event. Interestingly, regardless of HIV status, younger MSM had significantly lower BMD than older MSM, heterosexual men, and women.
The observed lower BMD in treated HIV-positive individuals was largely explained by both lower body weight and more smoking. Having experienced symptomatic HIV disease, often associated with weight loss, was another risk factor. The low BMD observed in younger MSM remains unexplained and needs further study.
人类免疫缺陷病毒（HIV）和联合抗逆转录病毒疗法（cART）可能都导致HIV感染者骨质疏松和骨质减少的患病率较高。
我们采用双能X线吸收法，比较了年龄≥45岁的581名HIV阳性参与者（94.7%接受cART治疗）和520名HIV阴性参与者的腰椎、全髋和股骨颈骨密度（BMD）。这些参与者来自AGEhIV队列研究。我们使用多变量线性回归来研究HIV、HIV疾病特征、抗逆转录病毒治疗（ART）与BMD之间的独立关联。
研究人群主要由男男性行为者（MSM）组成。HIV感染者中骨质疏松症的患病率显著更高（13.3%对6.7%；P<0.001）。在调整体重和吸烟因素后，HIV阳性不再与BMD独立相关。在有美国疾病控制与预防中心B类或C类事件病史的HIV阳性者中，低体重与BMD的负相关性更强。有趣的是，无论HIV感染状况如何，年轻的MSM的BMD显著低于年长的MSM、异性恋男性和女性。
在接受治疗的HIV阳性个体中观察到的较低BMD在很大程度上可归因于较低的体重和更多的吸烟行为。经历过有症状的HIV疾病（通常与体重减轻有关）是另一个危险因素。在年轻MSM中观察到的低BMD仍无法解释，需要进一步研究。
