Department of Internal Medicine, Severo Ochoa University Hospital, Leganés, Madrid, Spain.
Department of Endocrinology, Severo Ochoa University Hospital, Leganés, Madrid, Spain.
PLoS One. 2018 Apr 30;13(4):e0196201. doi: 10.1371/journal.pone.0196201. eCollection 2018.
Several studies have involved antiretroviral therapy in the pathogenesis of low bone mineral density (BMD), while others have not confirmed this association. In this study we analyze the impact of HIV status, traditional risk factors and antiretroviral therapy in BMD in an HIV-infected population living in Madrid.
We performed a cross-sectional analysis of 107 individuals infected with HIV and exposed to antiretroviral treatment to estimate the prevalence of decreased BMD. Bone mineral density of lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. In a multivariate analysis variables related with HIV status, antiretroviral drugs and traditional risk factors were included.
Low BMD was diagnosed in 63 participants (58.9%), including osteoporosis in 11 (10%). At least one cause of osteoporosis was identified in 43 patients (40%), with a deficiency of vitamin D in 86 (89%) and secondary hyperparathyroidism in 30 (28%). In multivariate analysis, increasing age, a treatment based on boosted PI and tenofovir DF, and previous exposure to tenofovir were identified as independent risk factors for a decreased BMD in both lumbar spine and femoral neck.
We have confirmed a high prevalence of reduced BMD, which is favoured by ritonavir-boosted PI and TDF. Bone safety should continue to be evaluated in clinical trials and cohort studies in order to demonstrate that the new drugs offer additional advantages regarding the impact on BMD.
一些研究涉及抗逆转录病毒疗法在低骨密度（BMD）发病机制中的作用，而其他研究则没有证实这种关联。本研究我们分析了 HIV 状态、传统危险因素和抗逆转录病毒治疗对马德里 HIV 感染者 BMD 的影响。
我们对 107 名接受抗逆转录病毒治疗的 HIV 感染者进行了横断面分析，以估计低 BMD 的患病率。通过双能 X 线吸收法测量腰椎和股骨颈的骨矿物质密度。在多变量分析中，纳入了与 HIV 状态、抗逆转录病毒药物和传统危险因素相关的变量。
63 名参与者（58.9%）被诊断为低 BMD，包括 11 名（10%）骨质疏松症患者。在 43 名（40%）患者中确定了至少一种骨质疏松症的原因，其中 86 名（89%）维生素 D 缺乏，30 名（28%）甲状旁腺功能亢进。多变量分析表明，年龄增长、基于增效 PI 的治疗和替诺福韦 DF 的先前暴露是腰椎和股骨颈 BMD 降低的独立危险因素。
我们证实了低 BMD 的高患病率，这 favored 利托那韦增效 PI 和 TDF。为了证明新药在对 BMD 的影响方面提供了额外的优势，应继续在临床试验和队列研究中评估骨安全性。
