Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
Arch Osteoporos. 2021 Feb 24;16(1):41. doi: 10.1007/s11657-021-00890-0.
This is the first 5-year analysis among persons with HIV (PWH) that reports both trabecular bone score (TBS), which is a novel index that estimates bone microarchitecture, and bone mineral density (BMD) over time to evaluate the long-term impact of antiretroviral therapy (ART) on bone health.
HIV infection and antiretroviral therapy (ART) have been associated with decreased bone mineral density (BMD). This study aims to evaluate long-term changes in trabecular bone score (TBS), a novel index that estimates bone microarchitecture, and BMD among Chinese persons with HIV (PWH) treated with ART.
We conducted a retrospective chart review of adult PWH at a large tertiary care hospital in China. Patients who had a DXA scan prior to ART and at least one follow-up DXA after ART initiation were included. Subgroup analyses examined the TBS and BMD changes in patients who switch from a non-TDF-containing regimen to one containing TDF, as compared to those who did not switch.
Four hundred fifty-nine PWH were included. Among 68 patients ≥ 50 years, 13 patients (19.1%) had a normal BMD but partially degraded or degraded TBS. The mean percent decrease in lumbar spine (LS) BMD nadired at 48 weeks after ART initiation and then gradually improved. Percent decrease in femoral neck (FN) and total hip (TH) BMD nadired at 96 weeks and remained stably low thereafter. After switch to a TDF-containing regimen, only percent change in TH BMD was significant (-3.2%, p = 0.006). In the regression analyses, switch to a TDF-containing regimen was not associated with long-term change in TBS or BMD.
This is the first study among PWH to evaluate the long-term impact of ART on TBS and BMD. At baseline, approximately 20% of patients had a normal BMD but impaired bone microstructure based upon TBS. For patients with 5 years of exposure to ART, there is a stabilization of TBS and BMD after initial nadir in the first 144 weeks. However, FN BMD, TH BMD, and TBS remained low at 5 years relative to baseline.
这是第一项针对艾滋病毒感染者（PWH）的 5 年分析报告，该报告同时报告了骨小梁评分（TBS）和骨密度（BMD），前者是一种评估骨微观结构的新指标，后者是随时间评估抗逆转录病毒疗法（ART）对骨骼健康长期影响的指标。
艾滋病毒感染和抗逆转录病毒疗法（ART）与骨密度降低有关。本研究旨在评估中国接受 ART 治疗的 HIV 感染者（PWH）的骨小梁评分（TBS）和 BMD 的长期变化，TBS 是一种评估骨微观结构的新指标。
我们对中国一家大型三级保健医院的成年 PWH 进行了回顾性图表审查。纳入了在开始 ART 之前进行过 DXA 扫描且在开始 ART 后至少有一次随访 DXA 的患者。亚组分析比较了从不含 TDF 的方案转换为含 TDF 的方案的患者与未转换的患者的 TBS 和 BMD 变化。
共纳入 459 例 PWH。在 68 名年龄≥50 岁的患者中，有 13 名患者（19.1%）BMD 正常，但骨小梁结构部分退化或退化。腰椎（LS）BMD 在 ART 开始后 48 周时的最低值逐渐改善。股骨颈（FN）和全髋关节（TH）BMD 的最低值在 96 周时达到，此后保持稳定低值。转换为含 TDF 的方案后，只有 TH 骨密度的变化有统计学意义（-3.2%，p=0.006）。在回归分析中，转换为含 TDF 的方案与 TBS 或 BMD 的长期变化无关。
这是第一项针对 PWH 评估 ART 对 TBS 和 BMD 的长期影响的研究。在基线时，约 20%的患者 BMD 正常，但 TBS 显示骨微观结构受损。对于接受 ART 治疗 5 年的患者，在最初的 144 周内达到最低值后，TBS 和 BMD 稳定。然而，FN BMD、TH BMD 和 TBS 在 5 年时仍低于基线。
