Tinago Willard, Cotter Aoife G, Sabin Caroline A, Macken Alan, Kavanagh Eoin, Brady Jennifer J, McCarthy Geraldine, Compston Juliet, Mallon Patrick W G
aHIV Molecular Research Group, Catherine McAuley Education and Research Centre, School of Medicine, University College Dublin, Dublin, Ireland bDepartment of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe cDepartment of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland dResearch Department of Infection and Population Health, University College London, London, UK eDepartment of Radiology fDepartment of Clinical Chemistry and Diagnostic Endocrinology gDepartment of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland hDepartment of Medicine, Cambridge Biomedical Campus, Cambridge, UK.
AIDS. 2017 Mar 13;31(5):643-652. doi: 10.1097/QAD.0000000000001372.
Although low bone mineral density (BMD) is prevalent in HIV, changes in BMD over time remain unclear. We aimed to compare rates of, and factors associated with, BMD change between HIV-positive and HIV-negative patients.
In a prospective, 3-year cohort, HIV-positive and HIV-negative patients provided annual demographic and clinical data, fasting bloods, and dual x-ray absorptiometry. Using longitudinal mixed models we compared and determined predictors of rate of change in BMD.
Of 384 study participants (45.8% HIV positive), 120 contributed two and 264 contributed three BMD measurements. Those with HIV were younger [median interquartile range 39 (34-46) vs. 43 (35-50) years; P = 0.04], more often men (61 vs. 46%; P = 0.003), and less likely Caucasian (61 vs. 82%; P < 0.001). Although BMD was lower in those with HIV, BMD declined in both groups, with nonsignificant between-group difference in rate of BMD change over time. Within the HIV group, starting antiretroviral therapy (ART) within 3 months of enrolment was associated with greater BMD decline at all anatomical sites (all P < 0.001). Age more than 30 years, Caucasian ethnicity, and not being on ART during follow-up were associated with greater decline and higher parathyroid hormone associated with a smaller decline in BMD at the femoral neck. We found no association between BMD change and exposure to tenofovir disoproxil fumarate or protease inhibitors.
We observed no difference in rate of BMD decline regardless of HIV status and in HIV-positive patient, having started ART within the previous 3 months was the only factor associated with greater BMD decline at all three sites.
虽然低骨矿物质密度（BMD）在HIV感染者中很常见，但BMD随时间的变化仍不清楚。我们旨在比较HIV阳性和HIV阴性患者之间BMD变化的速率及相关因素。
在一项为期3年的前瞻性队列研究中，HIV阳性和HIV阴性患者每年提供人口统计学和临床数据、空腹血液样本以及双能X线吸收测定法检查结果。我们使用纵向混合模型比较并确定BMD变化速率的预测因素。
在384名研究参与者中（45.8%为HIV阳性），120人提供了两次BMD测量数据，264人提供了三次BMD测量数据。HIV感染者更年轻[年龄中位数（四分位间距）为39（34 - 46）岁，而对照组为43（35 - 50）岁；P = 0.04]，男性比例更高（61%对46%；P = 0.003），白种人比例更低（61%对82%；P < 0.001）。虽然HIV感染者的BMD较低，但两组的BMD均下降，且随时间推移BMD变化速率的组间差异无统计学意义。在HIV组中，入组后3个月内开始抗逆转录病毒治疗（ART）与所有解剖部位的BMD下降幅度更大相关（所有P < 0.001）。年龄超过30岁、白种人以及随访期间未接受ART与更大幅度的BMD下降相关，而甲状旁腺激素水平较高与股骨颈BMD下降幅度较小相关。我们发现BMD变化与富马酸替诺福韦二吡呋酯或蛋白酶抑制剂的暴露之间无关联。
无论HIV感染状态如何，我们观察到BMD下降速率无差异，而在HIV阳性患者中，在过去3个月内开始ART是与所有三个部位BMD下降幅度更大相关的唯一因素。
