title: Is bone loss linked to chronic inflammation in antiretroviral-naive HIV-infected adults? A 48-week matched cohort study.
abstract: OBJECTIVE
  Antiretroviral therapy (ART) has been implicated in bone loss in HIV. The role of inflammation and vitamin D is unclear and better investigated in ART-naive individuals.
  
  
  METHODS
  This is a 48-week, prospective cohort study to compare baseline and change in hip and spine bone mineral density (BMD) measured by dual-energy X-ray absorptiometry in HIV-infected, ART-naive adults and healthy controls matched by age, sex, and race. We also studied associations between bone loss and inflammation markers and plasma 25-hydroxyvitamin D [25(OH)D] using logistic regression.
  
  
  RESULTS
  Forty-seven HIV-infected adults and 41 controls were included. Baseline 25(OH)D, BMD at total hip, trochanter, and spine, and prevalence of osteopenia and osteoporosis were similar between groups. In the HIV-infected group, total hip and trochanter, but not spine, BMD decreased over 48 weeks [hip -0.005 (-0.026-0.008) g/cm², P = 0.02 within group; trochanter -0.013 (-0.03-0.003), P < 0.01]. BMD did not change at any site within controls. The HIV-infected group was more likely to have bone loss at the trochanter (P = 0.03). This risk persisted after adjustment for age, sex, race, BMI, smoking, and hepatitis C (odds ratio 4, 95% confidence interval 1.2-15.8). In the HIV-infected group, higher interleukin-6 concentrations (P = 0.04) and Caucasian race (P < 0.01) were independently associated with progression to osteopenia or osteoporosis, but not 25(OH)D levels.
  
  
  CONCLUSIONS
  BMD at the total hip and trochanter sites decreased in the HIV-infected, ART-naive adults, but not controls, over this 48-week study. Higher serum interleukin-6 concentrations were associated with progression to osteopenia or osteoporosis status in the HIV-infected group.
authors.affiliation: aCase Western Reserve University School of Medicine bMetroHealth Medical Center cUniversity Hospitals Case Medical Center, Cleveland, Ohio dEmory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Corrilynn O
authors.initials: CO
authors.lastname: Hileman
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Labbato
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Storer
authors.forename: Vin
authors.initials: V
authors.lastname: Tangpricha
authors.forename: Grace A
authors.initials: GA
authors.lastname: McComsey
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology*; D006615:Hip / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013131:Spine / Q000473:pathology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D