Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
PLoS One. 2022 Nov 21;17(11):e0277231. doi: 10.1371/journal.pone.0277231. eCollection 2022.
There are limited data regarding bone health in older people living with HIV (PWH), especially those of Asian ethnicity. We aimed to determine whether BMD in well-suppressed HIV-infected men and women aged ≥ 50 years are different from HIV-uninfected controls. In a cross-sectional study, BMD by dual-energy X-ray absorptiometry and calciotropic hormones were measured. A total of 481 participants were consecutively enrolled (209 HIV+ men, 88 HIV- men, 126 HIV+ women and 58 HIV- women). PWH were on average 2.5 years younger [men: 55.0 vs. 57.5 yr; women: 54.0 vs. 58.0 yr] and had lower body mass index (BMI) [men: 23.2 vs. 25.1 kg/m2; women: 23.1 vs. 24.7 kg/m2] compared to the controls. The median duration since HIV diagnosis was 19 (IQR 15-21) years in men and 18 (IQR 15-21) years in women. Three-quarters of PWH had been treated with tenofovir disoproxil fumarate-containing antiretroviral therapy for a median time of 7.4 (IQR 4.5-8.9) years in men and 8.2 (IQR 6.1-10) years in women. In an unadjusted model, HIV+men had significantly lower BMD (g/cm2) at the total hip and femoral neck whereas there was a tend toward lower BMD in HIV+women. After adjusting for age, BMI, and other traditional osteoporotic risk factors, BMD of virologically suppressed older PWH did not differ from participants without HIV (P>0.1). PWH had lower serum 25(OH)D levels but this was not correlated with BMD. In conclusion, BMD in well-suppressed PWH is not different from non-HIV people, therefore, effective control of HIV infection and minimization of other traditional osteoporosis risk factors may help maintain good skeletal health and prevent premature bone loss in Asian PWH. Clinical trial registration: Clinicaltrials.gov # NCT00411983.
目前关于老年 HIV 感染者（PWH）的骨骼健康数据有限，尤其是亚洲人群。本研究旨在明确 50 岁以上病毒学抑制的 HIV 感染者与未感染 HIV 者的骨密度（BMD）是否存在差异。采用双能 X 线吸收法和钙调节激素对参与者进行 BMD 检测。共纳入 481 例参与者（209 例 HIV+男性、88 例 HIV-男性、126 例 HIV+女性和 58 例 HIV-女性）。与对照组相比，PWH 的平均年龄小 2.5 岁[男性：55.0 岁 vs. 57.5 岁；女性：54.0 岁 vs. 58.0 岁]，体重指数（BMI）低[男性：23.2 kg/m2 vs. 25.1 kg/m2；女性：23.1 kg/m2 vs. 24.7 kg/m2]。男性和女性的 HIV 诊断后中位时间分别为 19（IQR 15-21）年和 18（IQR 15-21）年。75%的 PWH 接受了含有替诺福韦二吡呋酯的抗逆转录病毒治疗，治疗时间中位数分别为男性 7.4（IQR 4.5-8.9）年和女性 8.2（IQR 6.1-10）年。未校正模型中，与 HIV-男性相比，HIV+男性的全髋和股骨颈 BMD 显著降低，而 HIV+女性的 BMD 也有降低的趋势。在校正年龄、BMI 和其他传统骨质疏松危险因素后，病毒学抑制的老年 PWH 的 BMD 与无 HIV 者无差异（P＞0.1）。PWH 的血清 25（OH）D 水平较低，但与 BMD 无相关性。总之，在充分抑制病毒的情况下，PWH 的 BMD 与非 HIV 人群无差异，因此，有效控制 HIV 感染和减少其他传统骨质疏松危险因素可能有助于维持亚洲 PWH 的骨骼健康，防止其发生过早的骨质流失。临床试验注册：Clinicaltrials.gov # NCT00411983。
