Donà D, Mozzo E, Luise D, Lundin R, Padoan A, Rampon O, Giaquinto C
Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100, Padua, Italy.
PENTA Foundation, 35100, Padua, Italy.
J Osteoporos. 2019 Jan 1;2019:1279318. doi: 10.1155/2019/1279318. eCollection 2019.
Daily assumption of antiretroviral drugs and HIV-related immune activation lead to important side effects, which are particularly evident in vertically infected patients. Bone homeostasis impairment and reduction of bone mineral density (BMD) is one of the most important side effects. Primary aim of this study is to assess the prevalence of bone homeostasis alterations in a group of vertically infected patients; secondary aim is to analyze the relationship between bone homeostasis alterations and anthropometric data, severity of HIV infection, and antiretroviral therapy. We studied 67 patients with vertically transmitted HIV-1 (aged 6-31 years), followed by the Pediatric Infectious Disease Unit of the University Hospital of Padua, Italy. We analyzed bone turnover markers (P1NP and CTx) and we performed lumbar spine and femoral dual energy X-ray absorption densitometry (DXA). Personal and anthropometric data and information on HIV-infection severity and antiretroviral therapy were collected for all patients. We found that BMD values recorded by DXA showed a significant correlation with age, race, BMI, physical activity, and antiretroviral therapy duration. P1NP was increased in 43% of patients, while CTX in 61% of them. P1NP alteration was related to age, race, BMI, physical activity, therapy duration, and ever use of protease inhibitors and nucleotide reverse transcriptase inhibitors. CTX alteration was found to be correlated only with age. In conclusion, our study confirms that a wide percentage of HIV vertically infected patients show reduced BMD and impaired bone homeostasis. Strict monitoring is needed in order to early identify and treat these conditions.
每日服用抗逆转录病毒药物以及与HIV相关的免疫激活会导致重要的副作用，这在垂直感染患者中尤为明显。骨稳态受损和骨矿物质密度（BMD）降低是最重要的副作用之一。本研究的主要目的是评估一组垂直感染患者中骨稳态改变的患病率；次要目的是分析骨稳态改变与人体测量数据、HIV感染严重程度和抗逆转录病毒治疗之间的关系。我们研究了67例垂直传播HIV-1的患者（年龄6至31岁），由意大利帕多瓦大学医院的儿科传染病科进行随访。我们分析了骨转换标志物（P1NP和CTX），并进行了腰椎和股骨双能X线吸收骨密度测定（DXA）。收集了所有患者的个人和人体测量数据以及关于HIV感染严重程度和抗逆转录病毒治疗的信息。我们发现，DXA记录的BMD值与年龄、种族、BMI、身体活动和抗逆转录病毒治疗持续时间显著相关。43%的患者P1NP升高，而61%的患者CTX升高。P1NP改变与年龄、种族、BMI、身体活动、治疗持续时间以及是否曾使用蛋白酶抑制剂和核苷酸逆转录酶抑制剂有关。发现CTX改变仅与年龄相关。总之，我们的研究证实，很大比例的HIV垂直感染患者表现出BMD降低和骨稳态受损。需要进行严格监测以便早期识别和治疗这些情况。
