Department of Primary Care Medicine, University of Malaya Primary Care Research Group, University of Malaya, Kuala Lumpur, Malaysia.
Department of Medicine (Endocrine), University of Malaya, Kuala Lumpur, Malaysia.
Osteoporos Int. 2018 Mar;29(3):595-613. doi: 10.1007/s00198-017-4305-8. Epub 2017 Nov 20.
A meta-analysis was conducted to evaluate the prevalence of osteopenia/osteoporosis in human immunodeficiency virus (HIV)-infected individuals. The prevalence of osteopenia/osteoporosis in HIV-infected and antiretroviral therapy (ART)-treated individuals was significantly higher than respective controls. Evidence regarding bone loss within first year of HIV infection or ART initiation was preliminary.
The aim of the study is to systematically review published literature on the prevalence of osteopenia/osteoporosis and its associated risk factors in HIV-infected individuals.
A literature search was conducted from 1989 to 2015 in six databases. Full text, English articles on HIV-infected individuals ≥ 18 years, which used dual X-ray absorptiometry to measure BMD, were included. Studies were excluded if the prevalence of osteopenia/osteoporosis was without a comparison group, and the BMD/T-score were not reported.
Twenty-one cross sectional and eight longitudinal studies were included. The prevalence of osteopenia/osteoporosis was significantly higher in both HIV-infected [odds ratio (OR) = 2.4 (95%Cl: 2.0, 2.8) at lumbar spine, 2.6 (95%Cl: 2.2, 3.0) at hip] and ART-treated individuals [OR = 2.8 (95%Cl: 2.0, 3.8) at lumbar spine, 3.4 (95%Cl: 2.5, 4.7) at hip] when compared to controls. PI-treated individuals had an OR of 1.3 (95%Cl: 1.0, 1.7) of developing osteopenia/osteoporosis compared to controls. A higher proportion of tenofovir-treated individuals (52.6%) had lower BMD compared to controls (42.7%), but did not reach statistical significance (p = 0.248). No significant difference was found in the percent change of BMD at the lumbar spine, femoral neck, or total hip from baseline to follow-up between HIV-infected, PI-treated, tenofovir-treated, and controls. Older age, history of bone fracture, low BMI, low body weight, being Hispanic or Caucasian, low testosterone level, smoking, low CD4 cell count, lipodystrophy, low fat mass, and low lean body mass were associated with low BMD.
The prevalence of osteopenia/osteoporosis in HIV-infected and antiretroviral therapy (ART)-treated individuals was two times more compared to controls. However, evidence concerning bone loss within the first year of HIV infection and ART initiation was preliminary.
本研究旨在系统评价已发表的关于 HIV 感染者骨质疏松症及其相关危险因素的文献。
从 1989 年至 2015 年，在六个数据库中进行了文献检索。纳入了使用双能 X 线吸收法测量骨密度的 HIV 感染者（年龄≥18 岁）的全文、英文文章。如果骨质疏松症的流行率没有对照组，且未报告骨密度/T 评分，则排除研究。
共纳入 21 项横断面研究和 8 项纵向研究。与对照组相比，HIV 感染者（腰椎：优势比[OR]2.4[95%置信区间[CI]：2.0，2.8]；髋部：OR 2.6[95%CI：2.2，3.0]）和接受 ART 治疗的个体（腰椎：OR 2.8[95%CI：2.0，3.8]；髋部：OR 3.4[95%CI：2.5，4.7]）骨质疏松症的流行率显著更高。与对照组相比，接受蛋白酶抑制剂（PI）治疗的个体发生骨质疏松症的 OR 为 1.3（95%CI：1.0，1.7）。与对照组相比，接受替诺福韦治疗的个体（52.6%）的骨密度较低，但差异无统计学意义（p=0.248）。与 HIV 感染者、PI 治疗者、替诺福韦治疗者和对照组相比，腰椎、股骨颈或总髋部的骨密度在从基线到随访的百分比变化没有显著差异。年龄较大、骨折史、低 BMI、低体重、西班牙裔或白种人、低睾酮水平、吸烟、低 CD4 细胞计数、脂肪营养不良、低脂肪量和低瘦体重与低骨密度相关。
与对照组相比，HIV 感染者和接受抗逆转录病毒治疗（ART）的个体骨质疏松症的流行率增加了两倍。然而，关于 HIV 感染和 ART 开始后第一年的骨丢失的证据尚属初步。
