Abstract
BackgroundLow BMD (bone mineral density) has been described as a non–AIDS (Acquired Immune Deficiency Syndrome)-related event in HIV (human immunodeficiency virus)-patients but it is poorly studied in young HIV-infected men who have received no previous antiretroviral therapy.MethodsA cross-sectional study of 245 naïve-HIV-infected men over 21 and under 50 years old who voluntary attended the Infectious Disease Division appointment in Hospital Fundación Jimenez Díaz in Madrid, from January 1st, 2014 to September 30th, 2017. All subjects underwent a baseline DXA scan (dual energy x-ray absorptiometry) performed prior to start antiretroviral treatment. Further, all patients who started treatment between May 1st and September 30th, 2017 were invited to participate in a substudy on bone mineral metabolism. All the information was collected through clinical history and complementary questionnaire.ResultsThe mean age was 36.4 years, been 68% Caucasian, 29.3% Latin American and 2.7% African race. At the time of diagnosis, 91% of patients had stage-A (median CD4+ T-cell 481cells/μL, IQR, 320–659). 10% had a count below 200 CD4 cells/μL, and 40% had a CD4/CD8 cell-count-ratio below 0.4. Regarding lifestyle and risk factors, 14.1% presented underweight, 36.1% were not engage in any regular exercise, 51.9% were active smokers and 35.3% reported drug use. Low levels of vitamin D were seen in 87.6% of the study participants. Low BMD (Z-score <- 2.0) was found in 22.8% of the patients. It was only observed a significant association of Z-score in lumbar spine (LS) with CD8 and the CD4/CD8 ratio, and with alcohol for femoral neck (FN) measurement.ConclusionsWe find prevalence of increased bone involvement among naïve HIV-infected men under 50 years old. Further studies are necessary to evaluate if changes in actual guidelines are needed to assess BMD measurements in HIV-infected adult male patients under 50.
Highlights
Low bone mineral density (BMD) has been described as a non–AIDS (Acquired Immune Deficiency Syndrome)-related event in Human immunodeficiency virus (HIV)-patients but it is poorly studied in young HIVinfected men who have received no previous antiretroviral therapy
The aim of this study is to assess bone involvement and risk factors that may contribute to the onset of low BMD among adult HIV-infected men, who are naïve to antiretroviral therapy (ART)
The hospital attends more than 3000 people living with HIV (PLWH), over 95% of newly infected patients are men who have sex with men (MSM)
Summary
Low BMD (bone mineral density) has been described as a non–AIDS (Acquired Immune Deficiency Syndrome)-related event in HIV (human immunodeficiency virus)-patients but it is poorly studied in young HIVinfected men who have received no previous antiretroviral therapy. There has been a steady rise in so-called non–AIDS (Acquired Immune Deficiency Syndrome)-related events, such as cardiovascular events, non–AIDS-defining tumors, as well as bone involvement and abnormally low bone mineral density (BMD) [2]. The factors that contribute to increase bone involvement are widely known and include age, vitamin D deficiency, tobacco and alcohol consumption, a sedentary lifestyle, among others [8, 9] In addition to these factors, PLWH exhibit a marked proinflammatory state even after ART start [10]. It is expected that study participants will have the presence of an increased bone involvement than similar uninfected population, even prior to initiation of ART and under 50 years [11, 12], which could suggest the beginning of the bone study prior to 50 years of age
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