Petraglia Alycia, Leader Joseph K, Gingo Matthew, Fitzpatrick Meghan, Ries John, Kessinger Cathy, Lucht Lorrie, Camp Danielle, Morris Alison, Bon Jessica
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
PLoS One. 2017 Apr 27;12(4):e0176719. doi: 10.1371/journal.pone.0176719. eCollection 2017.
Age-related chronic diseases are prevalent in HIV-infected persons in the antiretroviral therapy (ART) era. Bone mineral density (BMD) loss and emphysema have separately been shown to occur at a younger age and with lesser risk exposure in HIV-infected compared to HIV-uninfected individuals. In non-HIV infected smokers, emphysema has been shown to independently predict low BMD. We hypothesized that emphysema would independently associate with thoracic vertebral bone attenuation, a surrogate for bone mineral density, in HIV-infected individuals.
Clinical, pulmonary function, and radiographic data were analyzed for 164 individuals from the University of Pittsburgh's HIV Lung Research Center cohort. Chest CT scans were used to quantify emphysema and compute Hounsfield Unit (HU) attenuation of the 4th, 7th, and 10th thoracic vertebrae. The association between mean HU attenuation values across the three vertebrae and radiographic emphysema, age, sex, body mass index (BMI), steroid use, viral load, CD4 count, and forced expiratory volume in the first second (FEV1) was assessed by univariate and multivariate analyses.
In univariate analysis, mean HU attenuation decreased with increasing age (p<0.001), pack years (p = 0.047), and percent emphysema (p<0.001). In a multivariable model, including pack years, age, sex, ART and steroid use, greater emphysema was independently associated with this surrogate marker of BMD in HIV-infected individuals (p = 0.034).
The association of emphysema with thoracic bone attenuation in HIV-infected individuals is consistent with previous reports in non-HIV infected smokers. These findings suggest that emphysema should be considered a potential marker of osteoporosis risk in HIV-infected individuals.
在抗逆转录病毒治疗（ART）时代，与年龄相关的慢性疾病在HIV感染者中很普遍。与未感染HIV的个体相比，已分别显示HIV感染者的骨矿物质密度（BMD）损失和肺气肿在更年轻的年龄发生，且风险暴露较低。在未感染HIV的吸烟者中，肺气肿已被证明可独立预测低骨密度。我们假设肺气肿会在HIV感染者中与胸椎骨衰减（骨矿物质密度的替代指标）独立相关。
对匹兹堡大学HIV肺部研究中心队列中的164名个体的临床、肺功能和影像学数据进行了分析。胸部CT扫描用于量化肺气肿，并计算第4、7和10胸椎的亨氏单位（HU）衰减。通过单变量和多变量分析评估三个椎体的平均HU衰减值与影像学肺气肿、年龄、性别、体重指数（BMI）、类固醇使用、病毒载量、CD4细胞计数和第一秒用力呼气量（FEV1）之间的关联。
在单变量分析中，平均HU衰减随着年龄增长（p<0.001）、吸烟包年数增加（p = 0.047）和肺气肿百分比增加（p<0.001）而降低。在一个多变量模型中，包括吸烟包年数、年龄、性别、ART和类固醇使用情况，肺气肿程度越高与HIV感染者中这种BMD替代标志物独立相关（p = 0.034）。
HIV感染者中肺气肿与胸椎骨衰减之间的关联与之前关于未感染HIV吸烟者的报道一致。这些发现表明，肺气肿应被视为HIV感染者骨质疏松风险的潜在标志物。
