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J Infect Dis. 2015 Feb 15;211(4):539-48. doi: 10.1093/infdis/jiu499. Epub 2014 Sep 1.

Low bone mineral density in patients with well-suppressed HIV infection: association with body weight, smoking, and prior advanced HIV disease.

Author information

1
Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development.
2
Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA).
3
Department of Endocrinology and Metabolism.
4
Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development Department of Neurology.
5
Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA) Public Health Service Amsterdam, Infectious Diseases Research.
6
Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA).
7
Department of Nuclear Medicine, Academic Medical Center.
8
Department of Internal Medicine/Endocrinology, VU University Medical Center.
9
Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA) Stichting HIV Monitoring, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Human immunodeficiency virus (HIV) and combination antiretroviral therapy (cART) may both contribute to the higher prevalence of osteoporosis and osteopenia in HIV-infected individuals.

METHODS:

Using dual-energy X-ray absorptiometry, we compared lumbar spine, total hip, and femoral neck bone mineral density (BMD) in 581 HIV-positive (94.7% receiving cART) and 520 HIV-negative participants of the AGEhIV Cohort Study, aged ≥45 years. We used multivariable linear regression to investigate independent associations between HIV, HIV disease characteristics, ART, and BMD.

RESULTS:

The study population largely consisted of men who have sex with men (MSM). Osteoporosis was significantly more prevalent in those with HIV infection (13.3% vs 6.7%; P<.001). After adjustment for body weight and smoking, being HIV-positive was no longer independently associated with BMD. Low body weight was more strongly negatively associated with BMD in HIV-positive persons with a history of a Centers for Disease Control and Prevention class B or C event. Interestingly, regardless of HIV status, younger MSM had significantly lower BMD than older MSM, heterosexual men, and women.

CONCLUSIONS:

The observed lower BMD in treated HIV-positive individuals was largely explained by both lower body weight and more smoking. Having experienced symptomatic HIV disease, often associated with weight loss, was another risk factor. The low BMD observed in younger MSM remains unexplained and needs further study.

KEYWORDS:

HIV; body weight; bone mineral density; men who have sex with men; osteopenia; osteoporosis

PMID:
25180239
DOI:
10.1093/infdis/jiu499
[Indexed for MEDLINE]

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