title: High Prevalence of Low Bone Mineral Density and Substantial Bone Loss over 4 Years Among HIV-Infected Persons in the Era of Modern Antiretroviral Therapy.
abstract: HIV-infected persons are living longer on combination antiretroviral therapy (cART) but experiencing more comorbidities including low bone mineral density (BMD). Using data from the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study), we determined the prevalence of low BMD (T-score below one standard deviation of the reference mean) and compared it with matched controls from the National Health and Nutrition Examination Survey (NHANES). We also assessed 4-year longitudinal BMD changes among participants virologically suppressed on cART. Of 653 participants included in this analysis (77% male, 29% black, median age 41 years, median CD4(+) cell count 464 cells/mm(3), 89% with HIV RNA <400 copies/ml), 51% and 10% had baseline osteopenia and osteoporosis, respectively. Low BMD at the femoral neck was significantly more prevalent than for the NHANES controls (47% versus 29%, p<0.001). Lower body mass index, nonwhite race, longer tenofovir exposure, older age, being unemployed or retired, and lower apolipoprotein E were independently associated with baseline osteoporosis. Among 170 participants virologically suppressed on cART and with longitudinal BMD data, 31% experienced substantial bone loss (≥5% BMD decline from baseline) over 4 years. Female sex, current smoking, and longer stavudine use were more common among participants who had substantial bone loss, although these variables failed to reach statistical significance. Low BMD was highly prevalent among HIV-infected persons. One-third of participants experienced substantial bone loss despite cART, suggesting the need for monitoring and potential clinical interventions.
authors.affiliation: 1 Division of Infectious Diseases, Washington University School of Medicine , Saint Louis, Missouri.
authors.forename: Gerome V
authors.initials: GV
authors.lastname: Escota
authors.affiliation: 2 Central Texas Veterans Healthcare System , Austin, Texas.
authors.forename: Kristin
authors.initials: K
authors.lastname: Mondy
authors.affiliation: 3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Tim
authors.initials: T
authors.lastname: Bush
authors.affiliation: 3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Lois
authors.initials: L
authors.lastname: Conley
authors.affiliation: 3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.affiliation: 1 Division of Infectious Diseases, Washington University School of Medicine , Saint Louis, Missouri.
authors.forename: Nur
authors.initials: N
authors.lastname: Önen
authors.affiliation: 4 Center of Global Health, Non-Communicable Diseases Unit, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.affiliation: 5 Division of Infectious Diseases, Brown University , Miriam Hospital, Providence, Rhode Island.
authors.forename: Erna Milunka
authors.initials: EM
authors.lastname: Kojic
authors.affiliation: 6 HIV Program, Hennepin County Medical Center and the University of Minnesota , Minneapolis, Minnesota.
authors.forename: Keith
authors.initials: K
authors.lastname: Henry
authors.affiliation: 7 Denver Infectious Disease Consultants , Denver, Colorado.
authors.forename: John
authors.initials: J
authors.lastname: Hammer
authors.affiliation: 8 Cerner Corporation , Vienna, Virginia.
authors.forename: K C
authors.initials: KC
authors.lastname: Wood
authors.affiliation: 9 National Jewish Health , Denver, Colorado.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Lichtenstein
authors.affiliation: 10 Division of Infectious Diseases, University of Alabama School of Medicine , Birmingham, Alabama.
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Overton
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001057:Apolipoproteins E / Q000097:blood; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010024:Osteoporosis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D012367:RNA, Viral / Q000097:blood*; D012307:Risk Factors; D000068698:Tenofovir / Q000627:therapeutic use; D014481:United States
chemical_list: D019380:Anti-HIV Agents; D001057:Apolipoproteins E; D012367:RNA, Viral; D000068698:Tenofovir