Prevalence of low bone mineral density among HIV patients on long‐term suppressive antiretroviral therapy in resource limited setting of western India

Abstract

Introduction: Bone mineral density (BMD) assessment in HIV patients is sparsely done in resource limited settings. Materials and Methods: We conducted a crosssectional study of BMD amongst HIV patients following up in our clinic from 1 June to 1 December 2013 by performing dualenergy Xray absorptiometry scan (Lunar Prodigy Advanced DXA System, GE Healthcare) of lumbar spine and hip. Patients on long term (]12 months), virologically suppressive antiretroviral therapy (ART) were included. Patients who were ART nave were included as control population. Virologic failures were excluded. Low BMD was defined by WHO Tscore criteria (normal: T score ] (1;osteopenia: T score between (1 and (2.5 SD; osteoporosis: T score 5 (2.5 SD). Baseline risk factors associated with low BMD like age, low BMI, lipoatrophy, diabetes mellitus, current smoking, current alcohol intake, steroid exposure and menopause were recorded. ARTrelated factors associated with low BMD like ART duration, exposure to tenofovir and exposure to protease inhibitors (PI) were studied. Results: A total of 536 patients (66% males, 496 ART experienced and 40 ART nave) were included in this analysis. Median age was 42 years, mean BMI 23.35 kg/m 2 and median CD4 count 146 cells/mm 3 . All ART experienced patients had plasma viral load B400 copies/ml. Prevalence of low BMD amongst ART naive and ART experienced patients was 67% (osteopenia: 70.4%, osteoporosis: 29.6%) and 80.4% (osteopenia: 63.4%, osteoporosis: 36.6%), respectively (p 00.05). Mean T scores at lumbar spine and hip for ART naive and ART experienced patients were (1.37 and (0.9 versus (1.56 and (1.48 (p 00.05), respectively. Age, low BMI, current smoking, menopause, baseline CD4 count and exposure to ART were factors significantly associated with low overall BMD on univariate regression analysis. On multivariable logistic regression analysis age (p B0.001), low BMI (p B0.001), current smoking (0.05) and menopause (0.03) were associated with low BMD. BMI decrease of 1 kg/m 2 and baseline CD4 decline of 50 cells/mm 3