长期接受 TDF 为基础的抗逆转录病毒治疗的 HIV 感染患者中，非酒精性脂肪性肝病与骨矿物质密度之间的关系。

Association between Nonalcoholic Fatty Liver Disease and Bone Mineral Density in HIV-Infected Patients Receiving Long-term TDF-Based Antiretroviral Therapy.

机构信息

Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.

Department of Ultrasonography, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.

出版信息

Curr HIV Res. 2021;19(1):40-46. doi: 10.2174/1570162X18999200917120449.

DOI:10.2174/1570162X18999200917120449

PMID:32940183

Abstract

BACKGROUND

Tenofovir (TDF) has a detrimental effect on bone mineral density (BMD), while nonalcoholic fatty liver disease (NAFLD) is associated with a lower BMD.

OBJECTIVE

To help understand the mutual effects of NAFLD and TDF on BMD, this study was designed to explore the potential association between NAFLD and BMD in HIV-infected patients receiving long-term TDF-based antiretroviral therapy (ART).

METHODS

A total of 89 HIV-infected patients who received TDF-based ART for more than three years were enrolled in this cross-sectional study. We measured BMD using an ultrasonic bone density apparatus, and liver ultrasonography was performed to determine the severity of the fatty liver. The association of NAFLD with BMD was examined using multiple logistic regression analyses.

RESULTS

Patients with NAFLD showed a worse BMD status than those without NAFLD. The incidence rates of osteopenia (42.86% versus 25.93%) and osteoporosis (17.14% versus 3.70%) were significantly higher in HIV-infected patients with NAFLD than in those without NAFLD. After multivariate adjustment, the odds ratio (OR) for patients with NAFLD exhibiting a worse BMD status compared with those without NAFLD was 4.49 (95% confidence interval [CI] 1.42, 14.15).

CONCLUSION

Based on our results, NAFLD was significantly associated with a worse BMD status, including osteopenia and osteoporosis, in HIV patients after receiving long-term TDF-based ART. Furthermore, we may want to avoid using TDF for ART in HIV-infected patients with NAFLD.

摘要

背景

替诺福韦（TDF）对骨密度（BMD）有不良影响，而非酒精性脂肪性肝病（NAFLD）与较低的 BMD 有关。

目的

为了帮助了解 NAFLD 和 TDF 对 BMD 的相互影响，本研究旨在探讨长期接受 TDF 为基础的抗逆转录病毒治疗（ART）的 HIV 感染患者中 NAFLD 与 BMD 之间的潜在关联。

方法

本横断面研究共纳入 89 例接受 TDF 为基础的 ART 治疗超过 3 年的 HIV 感染患者。我们使用超声骨密度仪测量 BMD，并进行肝脏超声检查以确定脂肪肝的严重程度。使用多因素逻辑回归分析来检查 NAFLD 与 BMD 的关联。

结果

患有 NAFLD 的患者的 BMD 状况比没有 NAFLD 的患者差。患有 NAFLD 的 HIV 感染患者中，骨质疏松症（42.86%比 25.93%）和骨质疏松症（17.14%比 3.70%）的发生率明显更高。经过多因素调整后，与没有 NAFLD 的患者相比，NAFLD 患者 BMD 状况较差的优势比（OR）为 4.49（95%置信区间[CI]为 1.42，14.15）。