Multiple factors of risk have been described to the osteoporosis (OSP) and fractures in people infected by human immunodeficiency virus (HIV). Antiretroviral treatment has changed the vital prognosis of these patients, nevertheless seems that antiretroviral treatments can cause a greater loss of bone mineral density (BMD). Experts support the use of densitometry screening for HIV-infected postmenopausal women and men older than 50 years.
Objectives: To evaluate BMD and risk factors for OSP in HIV-infected male patients undergoing antiretroviral therapy with tenofovir and/or an inhibitor of the protease that attended an outpatient clinic.
Materials and methods: 23 patients were included. Clinical factors: age, BMI, previous fractures, habits were investigated and serum calcium, phosphorus, 25(OH)vitamin D, HIV RNA, and CD4 lymphocyte were measured. Densitometry (Lunar iDXA GE c.v. in alive 1.2%) was made at lumbar spine L2L4 (LS), femoral neck (FN) and total hip (TH). Diagnosis of low bone mass was made using International Society for Clinical Densitometry Z-score criteria in the 4049 years age group and WHO T-score criteria in the >50-year age group.
Results: Median age was 47 years (range 2760). All patients had a indetectable viral load and CD4 518.52±251.24. Twelve patients presented coinfection by VHC. Median BMI was 25.4. No referred personal or familiar previous fracture. Other factors of risk for fracture were: tobacco (five patients) and use of corticoids (one patient). Biochemical levels (mg/dl): calcium 9.31±0.44, phosphorus 2.36±1.56, GOT 42.41±32.24, and GPT 60.32±51.66. Seven patients presented a deficiency of 25 (OH) vitamin D (<25 ng/ml) mean: 18.71±7.77.
BMD were: LS 1.077±0.194 g/cm2, T-score −0.7±1.9 Z-score −1.0±1.5, FN 0.935±0.201 g/cm2, T-score −1.1±1.5, Z-score −0.6±1.3, TH 0.928±0.192 g/cm2, T-score −1.2±1.4, and Z-score −0.7±1.2. Four patients had OSP and other four patients osteopenia.
Conclusion: To evaluate the BMD and status of vitamin D in patients with HIV can be important to identify those patients in risk of developing OSP and to need an antiosteoporotic treatment
17 May 2014 - 20 May 2014