Abstract：
OBJECTIVE: Different ART (antiretroviral therapy) options may affect the risk of osteopenia/osteoporosis in people living with HIV (PLWH) having increased life expectancy. Current guidelines recommend bone mineral density (BMD) measurement only in patients at risk. In our study, we investigated the prevalence of osteopenia/osteoporosis and associated risk factors in naive patients not receiving ART.
METHODS: This study included 116 newly diagnosed, ART naive HIV-positive patients who were studied retrospectively. Vitamin D level, BMD measurement, CD4 and CD8 count, CD4/CD8 ratio, HIV RNA level, body mass index and other risk parameters of ART naive patients were included in our study.
RESULTS: Of 116 patients, 103 were male and 13 female. 47.4% (osteoporosis in 4.3%, osteopenia in 43.1%) of patients had osteopenia/osteoporosis. The patients with osteopenia/osteoporosis had older age (39.2±11.0 vs 32.0±8.6, p=0.0001), lower vitamin D levels (16.0±5.0 vs 24.4±6.3, p=0.0001), lower BMI (body mass index) (23.0±4.0 vs 24.6±4.6 p<0.05), lower CD4 and CD8 counts (405.1±885.0 vs 467.3± 695.1; 849.9570.4 vs 1012.0±629.4 respectively, p<0.05). 41.8% had CD4 count ≤200/μL (vs 18.0%, p=0.005). No statistically significant differences were observed in terms of gender distribution, smoking, alcohol and drug use, comorbidities and, additional drug use and HIV RNA >100 000 copies/ml. In multivariate analysis, age and vitamin D level were significant and independent (p<0.05) risk factors with osteoporosis/osteopenia.
CONCLUSIONS: Being over 40 years of age, CD4 count ≤200/μL, vitamin D level <20 ng/mL and low BMI are the most important risk factors for osteopenia/osteoporosis in ART naive patients. Among these parameters, age and vitamin D level were significant and independent risk factors. These factors may guide the determination of the need for dual-energy x-ray absorptiometry (DXA) testing in ART naive patients and drug choices in the treatment plan.
METHODS: This study included 116 newly diagnosed, ART naive HIV-positive patients who were studied retrospectively. Vitamin D level, BMD measurement, CD4 and CD8 count, CD4/CD8 ratio, HIV RNA level, body mass index and other risk parameters of ART naive patients were included in our study.
RESULTS: Of 116 patients, 103 were male and 13 female. 47.4% (osteoporosis in 4.3%, osteopenia in 43.1%) of patients had osteopenia/osteoporosis. The patients with osteopenia/osteoporosis had older age (39.2±11.0 vs 32.0±8.6, p=0.0001), lower vitamin D levels (16.0±5.0 vs 24.4±6.3, p=0.0001), lower BMI (body mass index) (23.0±4.0 vs 24.6±4.6 p<0.05), lower CD4 and CD8 counts (405.1±885.0 vs 467.3± 695.1; 849.9570.4 vs 1012.0±629.4 respectively, p<0.05). 41.8% had CD4 count ≤200/μL (vs 18.0%, p=0.005). No statistically significant differences were observed in terms of gender distribution, smoking, alcohol and drug use, comorbidities and, additional drug use and HIV RNA >100 000 copies/ml. In multivariate analysis, age and vitamin D level were significant and independent (p<0.05) risk factors with osteoporosis/osteopenia.
CONCLUSIONS: Being over 40 years of age, CD4 count ≤200/μL, vitamin D level <20 ng/mL and low BMI are the most important risk factors for osteopenia/osteoporosis in ART naive patients. Among these parameters, age and vitamin D level were significant and independent risk factors. These factors may guide the determination of the need for dual-energy x-ray absorptiometry (DXA) testing in ART naive patients and drug choices in the treatment plan.
摘要：
目的：不同的ART（抗逆转录病毒疗法）选择可能会影响预期寿命延长的HIV感染者（PLWH）骨质减少/骨质疏松的风险。目前的指南建议仅在有风险的患者中测量骨矿物质密度（BMD）。在我们的研究中,我们调查了未接受ART治疗的初治患者的骨量减少/骨质疏松患病率及相关危险因素.
方法：这项研究包括116例新诊断，回顾性研究首次接受ART治疗的HIV阳性患者。维生素D水平,BMD测量,CD4和CD8计数，CD4/CD8比值,HIVRNA水平，我们的研究纳入了未接受ART治疗患者的体重指数和其他风险参数.
结果：在116名患者中，男性103人，女性13人。47.4%（骨质疏松症占4.3%，43.1%的骨量减少)患者有骨量减少/骨质疏松症。骨量减少/骨质疏松症患者年龄较大（39.2±11.0vs32.0±8.6，p=0.0001），较低的维生素D水平（16.0±5.0vs24.4±6.3，p=0.0001），较低的BMI（体重指数）（23.0±4.0vs24.6±4.6p<0.05），较低的CD4和CD8计数（分别为405.1±885.0和467.3±695.1；849.9570.4和1012.0±629.4，p<0.05)。41.8％的CD4计数≤200/μL（vs18.0％，p=0.005)。在性别分布方面没有观察到统计学上的显著差异,吸烟,酗酒和吸毒，合并症和，额外的药物使用和HIVRNA>100000拷贝/ml。在多变量分析中，年龄和维生素D水平是骨质疏松/骨量减少的显著且独立(p<0.05)的危险因素。
结论：年龄超过40岁，CD4计数≤200/μL,维生素D水平<20ng/mL和低BMI是首次接受ART治疗患者骨量减少/骨质疏松的最重要危险因素.在这些参数中，年龄和维生素D水平是显著和独立的危险因素。这些因素可以指导确定是否需要在非ART患者中进行双能X射线吸收测定（DXA）测试以及治疗计划中的药物选择。
方法：这项研究包括116例新诊断，回顾性研究首次接受ART治疗的HIV阳性患者。维生素D水平,BMD测量,CD4和CD8计数，CD4/CD8比值,HIVRNA水平，我们的研究纳入了未接受ART治疗患者的体重指数和其他风险参数.
结果：在116名患者中，男性103人，女性13人。47.4%（骨质疏松症占4.3%，43.1%的骨量减少)患者有骨量减少/骨质疏松症。骨量减少/骨质疏松症患者年龄较大（39.2±11.0vs32.0±8.6，p=0.0001），较低的维生素D水平（16.0±5.0vs24.4±6.3，p=0.0001），较低的BMI（体重指数）（23.0±4.0vs24.6±4.6p<0.05），较低的CD4和CD8计数（分别为405.1±885.0和467.3±695.1；849.9570.4和1012.0±629.4，p<0.05)。41.8％的CD4计数≤200/μL（vs18.0％，p=0.005)。在性别分布方面没有观察到统计学上的显著差异,吸烟,酗酒和吸毒，合并症和，额外的药物使用和HIVRNA>100000拷贝/ml。在多变量分析中，年龄和维生素D水平是骨质疏松/骨量减少的显著且独立(p<0.05)的危险因素。
结论：年龄超过40岁，CD4计数≤200/μL,维生素D水平<20ng/mL和低BMI是首次接受ART治疗患者骨量减少/骨质疏松的最重要危险因素.在这些参数中，年龄和维生素D水平是显著和独立的危险因素。这些因素可以指导确定是否需要在非ART患者中进行双能X射线吸收测定（DXA）测试以及治疗计划中的药物选择。
