Gupta Pulin Kumar, Singh Sanchit, Mahto Subodh Kumar, Sheoran Ankita, Garga Umesh Chand, Lal Ashok Kumar, Jain Piyush, Mathews Sujata Elizabeth
Department of Medicine, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Department of Radiology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Tzu Chi Med J. 2020 Apr 10;33(1):49-54. doi: 10.4103/tcmj.tcmj_177_19. eCollection 2021 Jan-Mar.
HIV virtually affects every organ system of the body. The skeletal system is no exception, and antiretroviral therapy (ART) has been implicated in bone diseases. However, not many studies have been done to evaluate bone disease in treatment (ART) naive HIV-infected patients, and hence, the present study was executed.
One hundred and twenty HIV-infected ART-naive patients and 80 age- and sex-matched healthy controls were recruited for this study. A thorough history and physical examination was done followed by laboratory investigations after an overnight fasting. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry scan at the level of lumbar spine, femur, and forearm.
Of 120 ART-naive HIV-infected cases, the prevalence of osteoporosis and osteopenia was 13% and 41%, respectively, as compared to 0% and 17.5% in controls ( < 0.001). The mean BMD in cases was 0.842 g/cm which was approximately 25% lesser than that in controls. Hypovitaminosis-D was seen in 100% of cases as compared to 65% of controls ( < 0.01). A significant association of low BMD was seen with HIV-infection ( < 0.001), low CD4 cell counts ( < 0.001), low Vitamin D levels ( < 0.001), long duration of disease ( < 0.04), history of opportunistic infections ( < 0.03), and history of tuberculosis in the past ( < 0.05).
Bone diseases such as osteoporosis and osteopenia characterized by low BMD are very common in HIV-infected patients. Virus , along with low CD4 cell counts and low Vitamin D levels are major predictors of pathological fractures in these individuals.
HIV几乎会影响身体的每个器官系统。骨骼系统也不例外，抗逆转录病毒疗法（ART）与骨病有关。然而，针对未经抗逆转录病毒治疗（ART）的HIV感染患者的骨病评估研究并不多，因此开展了本研究。
本研究招募了120例未经抗逆转录病毒治疗的HIV感染患者以及80例年龄和性别匹配的健康对照。进行了全面的病史采集和体格检查，之后在空腹过夜后进行实验室检查。采用双能X线吸收法扫描测量腰椎、股骨和前臂部位的骨密度（BMD）。
在120例未经抗逆转录病毒治疗的HIV感染病例中，骨质疏松症和骨质减少症的患病率分别为13%和41%，而对照组分别为0%和17.5%（P<0.001）。病例组的平均骨密度为0.842 g/cm，比对照组低约25%。100%的病例存在维生素D缺乏，而对照组为65%（P<0.01）。骨密度低与HIV感染（P<0.001）、CD4细胞计数低（P<0.001）、维生素D水平低（P<0.001）、病程长（P<0.04）、机会性感染史（P<0.03）以及既往结核病史（P<0.05）之间存在显著关联。
以骨密度低为特征的骨质疏松症和骨质减少症等骨病在HIV感染患者中非常常见。病毒以及低CD4细胞计数和低维生素D水平是这些个体发生病理性骨折的主要预测因素。
