Prevalence and risk factors for bone mineral density changes in antiretroviral therapy-naive human immunodeficiency virus-infected adults: A Chinese cohort study

Abstract

Background Studies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)- infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of lowBMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China. Methods The assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression. Results Among the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5%(7/156) of patients, respectively.The lumbar spine wasmost likely to have reducedBMD(49.4%[77/156]), and the proportion of osteopenia in the left hip (32.7%[51/156]) was higher than in the right hip (24.4%[38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9%[95/156]) was themost significant (L2, 53.2%[83/156]; L3, 45.5%[71/156]; L4, 52.6%[82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5%[21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2%[72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, lowbodymass index(BMI:<18.5 kg/m2) was positively associated with reducedBMD (Exp (B)= 39.743,95%confidence interval: 3.234-488.399, P = 0.004), andwas specifically positively correlated withBMDvalues at three sites (r = 0.335 at right hip, r = 0.327 at left hip, r = 0.311 at lumbar spine). Conclusion Reduced BMD was found in the majority of ART-naive HIV-infected patients and BMI was identified as an additional risk factor for reduced BMD. Our results show that BMD reduction was simultaneously present in the left hip, right hip, and lumbar spine among nearly one fifth of patients. Our work highlights the importance of closely monitoring BMD in ART-naive patients and provides a foundation for the clinical intervention of bone demineralization in them.