BACKGROUND: Reduced bone mineral density (BMD) is common in adults infected with human immunodeficiency virus (HIV). The role of proximal renal tubular dysfunction (PRTD) and alterations in bone metabolism in HIV-related low BMD are incompletely understood. METHODS: We quantified BMD (dual-energy x-ray absorptiometry), blood and urinary markers of bone metabolism and renal function, and risk factors for low BMD (hip or spine T score, -1 or less) in an ambulatory care setting. We determined factors associated with low BMD and calculated 10-year fracture risks using the World Health Organization FRAX equation. RESULTS: We studied 153 adults (98% men; median age, 48 years; median body mass index, 24.5; 67 [44%] were receiving tenofovir, 81 [53%] were receiving a boosted protease inhibitor [PI]). Sixty-five participants (42%) had low BMD, and 11 (7%) had PRTD. PI therapy was associated with low BMD in multivariable analysis (odds ratio, 2.69; 95% confidence interval, 1.09-6.63). Tenofovir use was associated with increased osteoblast and osteoclast activity (P< or = .002). The mean estimated 10-year risks were 1.2% for hip fracture and 5.4% for any major osteoporotic fracture. CONCLUSIONS: In this mostly male population, low BMD was significantly associated with PI therapy. Tenofovir recipients showed evidence of increased bone turnover. Measurement of BMD and estimation of fracture risk may be warranted in treated HIV-infected adults.
BACKGROUND: Reduced bone mineral density (BMD) is common in adults infected with human immunodeficiency virus (HIV). The role of proximal renal tubular dysfunction (PRTD) and alterations in bone metabolism in HIV-related low BMD are incompletely understood. METHODS: We quantified BMD (dual-energy x-ray absorptiometry), blood and urinary markers of bone metabolism and renal function, and risk factors for low BMD (hip or spine T score, -1 or less) in an ambulatory care setting. We determined factors associated with low BMD and calculated 10-year fracture risks using the World Health Organization FRAX equation. RESULTS: We studied 153 adults (98% men; median age, 48 years; median body mass index, 24.5; 67 [44%] were receiving tenofovir, 81 [53%] were receiving a boosted protease inhibitor [PI]). Sixty-five participants (42%) had low BMD, and 11 (7%) had PRTD. PI therapy was associated with low BMD in multivariable analysis (odds ratio, 2.69; 95% confidence interval, 1.09-6.63). Tenofovir use was associated with increased osteoblast and osteoclast activity (P< or = .002). The mean estimated 10-year risks were 1.2% for hip fracture and 5.4% for any major osteoporotic fracture. CONCLUSIONS: In this mostly male population, low BMD was significantly associated with PI therapy. Tenofovir recipients showed evidence of increased bone turnover. Measurement of BMD and estimation of fracture risk may be warranted in treated HIV-infected adults.
Authors: Kathleen Mulligan; David V Glidden; Peter L Anderson; Albert Liu; Vanessa McMahan; Pedro Gonzales; Maria Esther Ramirez-Cardich; Sirianong Namwongprom; Piotr Chodacki; Laura Maria Carvalo de Mendonca; Furong Wang; Javier R Lama; Suwat Chariyalertsak; Juan Vicente Guanira; Susan Buchbinder; Linda-Gail Bekker; Mauro Schechter; Valdilea G Veloso; Robert M Grant Journal: Clin Infect Dis Date: 2015-04-23 Impact factor: 9.079
Authors: Robert C Kalayjian; Jeffrey M Albert; Serge Cremers; Samir K Gupta; Grace A McComsey; Karin L Klingman; Carl J Fichtenbaum; Todd T Brown; Babafemi O Taiwo Journal: AIDS Date: 2018-11-13 Impact factor: 4.177
Authors: Julie A Womack; Joseph L Goulet; Cynthia Gibert; Cynthia Brandt; Chung Chou Chang; Barbara Gulanski; Liana Fraenkel; Kristin Mattocks; David Rimland; Maria C Rodriguez-Barradas; Janet Tate; Michael T Yin; Amy C Justice Journal: PLoS One Date: 2011-02-16 Impact factor: 3.240
Authors: Iwen F Grigsby; Lan Pham; Louis M Mansky; Raj Gopalakrishnan; Kim C Mansky Journal: Ther Clin Risk Manag Date: 2010-02-02 Impact factor: 2.423