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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2004 Marzo;48(1):39-48

 

Bone mass loss and vitamin D metabolism impairment in HIV patients receiving highly active antiretroviral therapy

Madeddu Giordano 1, Spanu A. 2, Solinas P. 2, Calia G. M. 1, Lovigu C. 1, Chessa F. 2, Mannazzu M. 1, Falchi A. 2, Mura M. S. 1, Madeddu Giuseppe 2

1 Department of Infectious Diseases University of Sassari, Sassari, Italy
2 Department of Nuclear Medicine University of Sassari, Sassari, Italy

Aim. Given the few con­tro­ver­sial ­data ­about the ­effect of high­ly ­active anti­ret­ro­vi­ral ther­a­py (­HAART) on ­bone ­mass in HIV ­patients, we inves­ti­gat­ed wheth­er a rela­tion­ship ­between oste­o­pe­nia/oste­o­por­o­sis ­risk and ­HAART ­exists.
Methods. In 172 HIV ­patients, 152 on ­HAART, 92 includ­ing and 60 not includ­ing pro­tease inhib­i­tors (PI), 20 ­naïve and 64 con­trols, we meas­ured ­spine/­femur ­bone min­er­al den­sity (BMD) by ­DEXA, and ­assayed ser­um oste­o­cal­cin (O), ­bone alka­line phos­pha­tase (BAP), 1,25(OH)2 D, par­a­thor­mone (PTH), cal­cium (Ca) and uri­nary pyri­din­ium ­cross-­links (PYD & DPD).
Results. Following WHO BMD t-­score cri­te­ria, oste­o­pe­nia was ascer­tained in >35% of all ­HAART ­groups and in 30% of ­naive. Only ­HAART ­patients had oste­o­por­o­sis, PI ­patients ­more fre­quent­ly, sig­nif­i­cant­ly (p<0.03) in ­spine (21.7% vs 8.3%). Males, intra­ve­nous ­drug ­users and B-C ­stage ­patients ­have a high­er ­risk for low ­bone ­mass. Mean t-­score was sig­nif­i­cant­ly low­er in ­both ­spine and ­femur and O and PYD & DPD high­er in PI ­than non PI ­patients and con­trols; 1,25(OH)2 D was sig­nif­i­cant­ly low­er in all HIV ­groups ­than con­trols, PI ­patients hav­ing the low­est val­ues pos­i­tive­ly cor­re­lat­ing ­with BMD and neg­a­tive­ly ­with OC and PYD & DPD, and it ­decreased fur­ther in 27 non select­ed mon­i­tored ­patients con­tin­u­ing on ­HAART. PTH was high­er and Ca low­er in ­HAART ­patients ­than con­trols but not sig­nif­i­cant­ly, PTH neg­a­tive­ly cor­re­lat­ing ­with BMD.
Conclusion. ­HAART ­could be asso­ciat­ed ­with oste­o­pe­nia, ­even oste­o­por­o­sis, and it ­could aggra­vate the ­loss in ­bone ­mass due to HIV infec­tion ­itself. We hypoth­e­size ­that ­HAART may direct­ly ­affect ­bone remod­el­ling and/or may indi­rect­ly ­affect vita­min D metab­olism.

lingua: Inglese


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