Relationship between low bone mineral density and highly active antiretroviral therapy including protease inhibitors in HIV-infected patients.
OBJECTIVE
The objectives of this study were to determine the prevalence of osteopenia and the factors associated with its presence in HIV-infected patients under highly active antiretroviral therapy (HAART) and to assess the changes of bone mineral density (BMD) in a population followed prospectively.


METHODS
BMD was assessed by dual-energy X-ray absorptiometry (DEXA) scans at the lumbar spine and at the femoral neck in 78 HIV-infected patients who had previously received HAART as the first antiretroviral regimen and in 11 antiretroviral-naive HIV-infected patients. BMD measurements were repeated in 70 treated patients who had completed 1 year of follow-up.


RESULTS
Thirty-seven (42%) patients showed osteopenia at any localization. The prevalence of osteopenia in PI-naive patients was 23% versus 49% in individuals who had received PI at any moment [p =.001; adjusted odds ratio (95% CI) = 0.11 (0.02-0.48)]. The frequency of osteopenia was significantly higher among men than among women [50% vs. 17%; p =.016; adjusted OR (95% CI) = 12.1 (2.22-66.20)]. The level of plasma albumin was independently associated with osteopenia [adjusted OR (95% CI) per each g/dL of plasma albumin decrease 2.55 (1.18-10)]. In patients in whom a second DEXA was done, no significant changes in BMD were found.


CONCLUSIONS
The prevalence of osteopenia in HIV-infected patients on HAART is high. Loss of BMD is associated with PI therapy, low plasma albumin level, and male sex. Osteopenia does not progress after 1 year of continued HAART.
Servicio de Medicina Interna, Hospital Universitario de Valme, Seville, Spain.
J
J
Fernández-Rivera
R
R
García
F
F
Lozano
J
J
Macías
J A
JA
García-García
J A
JA
Mira
J E
JE
Corzo
J
J
Gómez-Mateos
A
A
Rueda
J
J
Sánchez-Burson
J A
JA
Pineda
D015502:Absorptiometry, Photon; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000139:chemically induced* / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012709:Serum Albumin; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
D017320:HIV Protease Inhibitors; D012709:Serum Albumin