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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.