Microstructural alterations of trabecular and cortical bone in long-term HIV-infected elderly men on successful antiretroviral therapy

作者：Biver Emmanuel^*; Calmy Alexandra; Delhumeau Cecile; Durosier Claire; Zawadynski Sophie; Rizzoli Rene

来源：AIDS, 2014, 28(16): 2417-2427.

DOI：10.1097/QAD.0000000000000445

• bone microstructure
• bone mineral density
• HAARTs
• high-resolution
• peripheral quantitative computed tomography
• HIV

Objective: Progress in antiretroviral therapy (ART) has resulted in an almost normal life expectancy for HIV-infected individuals, but an increased risk of fragility fractures has been identified. We investigated the influence of long-term HIV infection on successful ART on bone microstructure in elderly men.
Design: A cross-sectional, case-control study.
Methods: Dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT) were performed in 28 HIV-positive men between 60 and 70 years old on successful ART. Controls were 112 HIV-negative men matched for age (+/- 4 years) and BMI (+/- 4 kg/m(2)).
Results: HIV-positive men (median CD4(+) cell count, 589 cells/mu l; BMI, 24.8 kg/m(2)) had a median duration of HIV infection of 18.2 years. Compared with HIV-negative men, they had a lower DXA-measured areal bone mineral density at total hip (- 3.2%, P = 0.050) and ultra-distal radius (- 8.4%, P = 0.001). At distal radius and tibia, we observed microstructural alterations with a lower total density (- 16%, P = 0.005 and - 14.3%, P = 0.039), trabecular density (- 11.6%, P = 0.012 and - 12.2%, P = 0.007) and cortical area (- 17.5%, P = 0.002 and - 12.2%, P = 0.01). In addition, they had a lower trabecular number (P = 0.036), higher trabecular spacing (P = 0.027) and lower cortical thickness (- 19.9%; P = 0.008) at distal radius. beta-crosslaps (CTX) and vitamin D levels were higher than in controls. By multivariate analyses, HIV status, higher CTX levels, lower physical activity and estradiol levels were determinants of bone density and microstructure alterations.
Conclusion: HIV-infected elderly men on successful ART have trabecular and cortical bone microstructure alterations associated with higher bone resorption, despite adequate vitamin D supplementation.

• 出版日期2014-10