Abstract
BackgroundAge-related chronic diseases are prevalent in HIV-infected persons in the antiretroviral therapy (ART) era. Bone mineral density (BMD) loss and emphysema have separately been shown to occur at a younger age and with lesser risk exposure in HIV-infected compared to HIV-uninfected individuals. In non-HIV infected smokers, emphysema has been shown to independently predict low BMD. We hypothesized that emphysema would independently associate with thoracic vertebral bone attenuation, a surrogate for bone mineral density, in HIV-infected individuals.MethodsClinical, pulmonary function, and radiographic data were analyzed for 164 individuals from the University of Pittsburgh’s HIV Lung Research Center cohort. Chest CT scans were used to quantify emphysema and compute Hounsfield Unit (HU) attenuation of the 4th, 7th, and 10th thoracic vertebrae. The association between mean HU attenuation values across the three vertebrae and radiographic emphysema, age, sex, body mass index (BMI), steroid use, viral load, CD4 count, and forced expiratory volume in the first second (FEV1) was assessed by univariate and multivariate analyses.ResultsIn univariate analysis, mean HU attenuation decreased with increasing age (p<0.001), pack years (p = 0.047), and percent emphysema (p<0.001). In a multivariable model, including pack years, age, sex, ART and steroid use, greater emphysema was independently associated with this surrogate marker of BMD in HIV-infected individuals (p = 0.034).ConclusionsThe association of emphysema with thoracic bone attenuation in HIV-infected individuals is consistent with previous reports in non-HIV infected smokers. These findings suggest that emphysema should be considered a potential marker of osteoporosis risk in HIV-infected individuals.
Highlights
The widespread introduction of highly effective antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has dramatically decreased HIV-associated mortality [1]
In a multivariable model, including pack years, age, sex, ART and steroid use, greater emphysema was independently associated with this surrogate marker of bone mineral density (BMD) in HIV-infected individuals (p = 0.034)
These findings suggest that emphysema should be considered a potential marker of osteoporosis risk in HIV-infected individuals
Summary
The widespread introduction of highly effective antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has dramatically decreased HIV-associated mortality [1]. The prevalence of chronic diseases, such as COPD and osteoporosis, has increased and occurred prematurely in the HIV-infected population [1,2,3,4,5,6]. Low bone mineral density (BMD) is a metabolic condition with increasing relevance in HIV-infected patients, with an estimated incidence that is three-fold greater than in the general HIV-uninfected population [3,4,7,8,9]. Chronic obstructive pulmonary disease (COPD) is associated with low BMD and greater fracture risk in non-HIV infected smokers [11,12]. Age-related chronic diseases are prevalent in HIV-infected persons in the antiretroviral therapy (ART) era. Bone mineral density (BMD) loss and emphysema have separately been shown to occur at a younger age and with lesser risk exposure in HIV-infected compared to HIV-uninfected individuals. We hypothesized that emphysema would independently associate with thoracic vertebral bone attenuation, a surrogate for bone mineral density, in HIV-infected individuals
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