title: Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women.
abstract: We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients.
  
  
  BACKGROUND
  Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations.
  
  
  METHODS
  We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age- and body mass index (BMI)-matched HIV-negative (-ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted.
  
  
  RESULTS
  In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5 ± 3.5 (mean ± SD) years; median BMI was 22 (IQR, 21-26) kg/m². More HIV+ve women were smokers (82 versus 50 %, p = 0.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score -0.70 vs -0.03, p = 0.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV-ve women (p = 0.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (-3.0 %; p = 0.029).
  
  
  CONCLUSIONS
  Compared with HIV-ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.
authors.affiliation: Division of Infectious Diseases, HIV Unit, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. Alexandra.calmy@hcuge.ch
authors.forename: A
authors.initials: A
authors.lastname: Calmy
authors.forename: T
authors.initials: T
authors.lastname: Chevalley
authors.forename: C
authors.initials: C
authors.lastname: Delhumeau
authors.forename: L
authors.initials: L
authors.lastname: Toutous-Trellu
authors.forename: R
authors.initials: R
authors.lastname: Spycher-Elbes
authors.forename: O
authors.initials: O
authors.lastname: Ratib
authors.forename: S
authors.initials: S
authors.lastname: Zawadynski
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015519:Bone Density / Q000502:physiology*; D016022:Case-Control Studies; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D010024:Osteoporosis / Q000503:physiopathology / Q000821:virology*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000503:physiopathology; D017697:Premenopause / Q000502:physiology; D011884:Radius / Q000503:physiopathology; D012307:Risk Factors; D013977:Tibia / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019380:Anti-HIV Agents