Liu Yao, Foreman Sarah C, Joseph Gabby B, Neumann Jan, Tien Phyllis C, Li Xiaoming, Lane Nancy E, Nevitt Michael C, McCulloch Charles E, Link Thomas M
Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BMC Musculoskelet Disord. 2019 May 4;20(1):190. doi: 10.1186/s12891-019-2573-5.
Metabolic disorders presenting in HIV-infected patients on antiretroviral therapy (ART) may increase the risk of osteoarthritis. However, structural changes of the knee in HIV infected subjects are understudied. The aim of this study is to investigate knee cartilage degeneration and knee structural changes over 8 years in subjects with and without HIV infection determined based on the use of ART.
We studied 10 participants from the Osteoarthritis Initiative who received ART at baseline and 20 controls without ART, frequency matched for age, sex, race, baseline body mass index (BMI) and Kellgren & Lawrence grade. Knee abnormalities were assessed using the whole-organ magnetic resonance imaging score (WORMS) and cartilage T2 including laminar and texture analyses were analyzed using a multislice-multiecho spin-echo sequence. Signal abnormalities of the infrapatellar fat pad (IPFP) and suprapatellar fat pad (SPFP) were assessed separately using a semi-quantitative scoring system. Linear regression models were used in the cross-sectional analysis to compare the differences between ART/HIV subjects and controls in T2 (regular and laminar T2 values, texture parameters) and morphologic parameters (subscores of WORMS, scores for signal alterations of IPFP and SPFP). Mixed effects models were used in the longitudinal analysis to compare the rate of change in T2 and morphological parameters between groups over 8 years.
At baseline, individuals on ART had significantly greater size of IPFP signal abnormalities (P = 0.008), higher signal intensities of SPFP (P = 0.015), higher effusion scores (P = 0.009), and lower subchondral cysts sum scores (P = 0.003) compared to the controls. No significant differences were found between the groups in T2-based cartilage parameters and WORMS scores for cartilage, meniscus, bone marrow edema patterns and ligaments (P > 0.05). Longitudinally, the HIV cohort had significantly higher global knee T2 entropy values (P = 0.047), more severe effusion (P = 0.001) but less severe subchondral cysts (P = 0.002) on average over 8 years.
Knees of individuals with HIV on ART had a more heterogeneous cartilage matrix, more severe synovitis and abnormalities of the IPFP and SPFP, which may increase the risk of incident knee osteoarthritis.
接受抗逆转录病毒疗法（ART）的HIV感染患者出现的代谢紊乱可能会增加患骨关节炎的风险。然而，HIV感染受试者膝关节的结构变化研究较少。本研究的目的是调查根据ART使用情况确定的有或无HIV感染的受试者在8年期间膝关节软骨退变和膝关节结构变化情况。
我们研究了骨关节炎倡议组织中的10名在基线时接受ART治疗的参与者和20名未接受ART治疗的对照者，在年龄、性别、种族、基线体重指数（BMI）和凯尔格伦-劳伦斯分级方面进行频率匹配。使用全器官磁共振成像评分（WORMS）评估膝关节异常情况，并使用多层多回波自旋回波序列分析软骨T2，包括层状和纹理分析。使用半定量评分系统分别评估髌下脂肪垫（IPFP）和髌上脂肪垫（SPFP）的信号异常。在横断面分析中使用线性回归模型比较ART/HIV受试者与对照组在T2（常规和层状T2值、纹理参数）和形态学参数（WORMS子评分、IPFP和SPFP信号改变评分）方面的差异。在纵向分析中使用混合效应模型比较两组在8年期间T2和形态学参数的变化率。
在基线时，与对照组相比，接受ART治疗的个体IPFP信号异常的大小显著更大（P = 0.008），SPFP信号强度更高（P = 0.015），积液评分更高（P = 0.009），软骨下囊肿总分更低（P = 0.003）。在基于T2的软骨参数以及软骨、半月板、骨髓水肿模式和韧带的WORMS评分方面，两组之间未发现显著差异（P > 0.05）。纵向来看，在8年期间，HIV队列的膝关节整体T2熵值显著更高（P = 0.047），积液更严重（P = 0.001），但软骨下囊肿不太严重（P = 0.002）。
接受ART治疗的HIV感染者的膝关节软骨基质更不均匀，滑膜炎更严重，IPFP和SPFP存在异常，这可能会增加发生膝关节骨关节炎的风险。
