Reduced Quantitative Ultrasound Bone Mineral Density in HIV-Infected Patients on Antiretroviral Therapy in Senegal

Amandine Cournil,Claire Moquet,Cécile Cames,Kirsten Bork,Papa Salif Sow,Julie Coutherut,Assane Diouf,Eric Delaporte,Ndèye Fatou Ngom Gueye,Sabrina Eymard-Duvernay,Bernard Taverne,Sean Emery

doi:10.1371/journal.pone.0031726

Abstract

BackgroundBone status in HIV-infected patients on antiretroviral treatment (ART) is poorly documented in resource-limited settings. We compared bone mineral density between HIV-infected patients and control subjects from Dakar, Senegal.MethodsA total of 207 (134 women and 73 men) HIV-infected patients from an observational cohort in Dakar (ANRS 1215) and 207 age- and sex-matched controls from the general population were enrolled. Bone mineral density was assessed by quantitative ultrasound (QUS) at the calcaneus, an alternative to the reference method (i.e. dual X-absorptiometry), often not available in resource-limited countries.ResultsMean age was 47.0 (±8.5) years. Patients had received ART for a median duration of 8.8 years; 45% received a protease inhibitor and 27% tenofovir; 84% had undetectable viral load. Patients had lower body mass index (BMI) than controls (23 versus 26 kg/m2, P<0.001). In unadjusted analysis, QUS bone mineral density was lower in HIV-infected patients than in controls (difference: −0.36 standard deviation, 95% confidence interval (CI): −0.59;−0.12, P = 0.003). Adjusting for BMI, physical activity, smoking and calcium intake attenuated the difference (−0.27, CI: −0.53;−0.002, P = 0.05). Differences in BMI between patients and controls explained a third of the difference in QUS bone mineral density. Among patients, BMI was independently associated with QUS bone mineral density (P<0.001). An association between undetectable viral load and QUS bone density was also suggested (β = 0.48, CI: 0.02;0.93; P = 0.04). No association between protease inhibitor or tenofovir use and QUS bone mineral density was found.ConclusionSenegalese HIV-infected patients had reduced QUS bone mineral density in comparison with control subjects, in part related to their lower BMI. Further investigation is needed to clarify the clinical significance of these observations.

Highlights

Reduced bone mineral density is a recognized metabolic complication of HIV and its treatment
Its use in clinical practice is still not well defined and depends on the type of device; for epidemiological purposes, it provides an appropriate tool for comparing bone mineral density between different groups and identifying factors associated with variation in bone density, especially in settings where dual-energy x-ray absorptiometry (DXA) is not available [10,11]
Compared with patients included in the analysis, non-enrolled or non-analyzed patients were more likely to be male (58.3% vs 35.3%; P = 0.001) and to have received protease inhibitor (PI) (60.0% vs 44.9%; P = 0.04) or tenofovir disoproxyl fumarate (TDF) (43.3% vs. 26.6%; P = 0.01)

Summary

Introduction

Reduced bone mineral density is a recognized metabolic complication of HIV and its treatment. Sub-Saharan Africa, this region houses two-thirds of the persons living with HIV worldwide. This situation is primarily due to the lack of specific equipment for assessing bone mineral density by dual-energy x-ray absorptiometry (DXA). Recent developments in densitometry technology have provided alternative methods, among which heel quantitative ultrasound (QUS) appears to be the most widely used [5]. It is inexpensive, portable, ionizing-radiation-free and proven to predict hip fractures and all osteoporotic fractures in Caucasian postmenopausal women and elderly men [6,7,8,9]. We compared bone mineral density between HIV-infected patients and control subjects from Dakar, Senegal

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