title: Reduced quantitative ultrasound bone mineral density in HIV-infected patients on antiretroviral therapy in Senegal.
abstract: BACKGROUND
  Bone 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Mean 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/m(2), 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.
  
  
  CONCLUSIONS
  Senegalese 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.
authors.affiliation: Institut de Recherche pour le Développement/University Montpellier 1, UMI 233, Montpellier, France. amandine.cournil@ird.fr
authors.forename: Amandine
authors.initials: A
authors.lastname: Cournil
authors.forename: Sabrina
authors.initials: S
authors.lastname: Eymard-Duvernay
authors.forename: Assane
authors.initials: A
authors.lastname: Diouf
authors.forename: Claire
authors.initials: C
authors.lastname: Moquet
authors.forename: Julie
authors.initials: J
authors.lastname: Coutherut
authors.forename: Ndèye Fatou
authors.initials: NF
authors.lastname: Ngom Gueye
authors.forename: Cécile
authors.initials: C
authors.lastname: Cames
authors.forename: Bernard
authors.initials: B
authors.lastname: Taverne
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bork
authors.forename: Papa Salif
authors.initials: PS
authors.lastname: Sow
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000494:pharmacology / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D012675:Senegal; D000068698:Tenofovir; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D063065:Organophosphonates; D011480:Protease Inhibitors; D000068698:Tenofovir; D000225:Adenine