Abstract
Objective: The purpose of our study was to evaluate the alterations of bone metabolism and the prevalence of vertebral fractures in the population with HIV and hepatitis B and C seropositivity in treatment with antiretroviral drugs (HAART).Methods: We selected 83 patients with diagnosis of HIV, HBV, HCV infection. In all these patients biochemical examinations of phospho-calcium metabolism and a densitometry of lumbar spine were performed. We also evaluated lateral spine X-rays in order to analyze the presence of vertebral deformities and to define their severity. As a control group we analyzed the prevalence of vertebral fractures in a group of 40 non-infectious patients.Results: We selected 82 seropositive patients, 46 males and 37 females, with a median age of 55 ± 10 years. Out of these patients, 55 were infected by HIV, 12 were infected by HBV, 11 presented HIV and HCV co-infection and 4 were HCV+. The prevalence of hypovitaminosis D in the studied population was 53%, while the prevalence of osteoporosis and osteopenia was 14 and 48%, respectively. The average T-score in the fractured population was −1.9 SD. The viral load and the CD4+ cell count were respectively, directly, and inversely correlated with the number and severity of vertebral fractures. Antiretroviral therapy regimen containing TDF and PI was a significant determinant of the presence of vertebral deformities. The use of these drugs was also associated with lower levels of vitamin D and higher bone turnover levels compared to other antiretroviral drugs.Conclusions: HIV patients suffer from bone fragility, particularly at spine, independently by the level of bone mineral density. In this population, the T-score threshold for the risk of fracture is higher than that usually used in general population. For this reason, it would be indicated to perform an X-ray of the spine in order to detect vertebral deformities even in patients with a normal or slighlty reduced bone mineral density.
Highlights
The introduction of antiretroviral therapy (ART) has certainly improved the prognosis of HIV patients by reducing their mortality and morbidity, but has revealed some complications related to the therapy
For every patients we considered the principal epidemiological, clinical, immunological and virological risk factors for osteoporosis: sex, age, race, weight, CD4+ cell count, HIV viral load, AIDS diagnosis, protease inhibitors and NNRTI exposure, hepatitis C co-infection, vitamin D deficiency, chronic renal insufficiency, menopause
Our study showed a very high prevalence of vertebral fractures in patients infected by HIV and hepatitis viruses: the 41% of the studied population showed at least one vertebral deformity
Summary
The introduction of antiretroviral therapy (ART) has certainly improved the prognosis of HIV patients by reducing their mortality and morbidity, but has revealed some complications related to the therapy. The evidence of a greater prevalence of reduced Bone Mineral Density (BMD), osteopenia and osteoporosis in the HIV+ population than the control population has emerged and has been widely studied [1,2,3,4,5]. An important meta-analysis of studies comparing BMD between HIV patients with normal population showed a prevalence of reduced BMD in 67% of people with HIV and a prevalence of 15% of osteoporosis in this population [6]. A more recent study shows that even in newly diagnosed, therapynaive HIV-infected patients, without any known secondary causes of osteoporosis, low BMD and high bone resorption are significantly prevalent [7]. As a consequence of reduced BMD, patients with HIV infection are more likely to present with fragility fractures [10,11,12,13,14]
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