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3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV23-26 October 2001, Athens, Greece |
Osteoporosis and osteopenia in treated and not treated HIV-positive patients
Antiviral Therapy 2001; 6(Suppl. 4):25 (abstract no. 32)
C Amiel1, L Slama1, A Ostertag2, T NGuyen1, L Nai-Ighil1, S Gharakhanian1, E Lajeunie3, MC de Vernejoul2 and W Rozenbaum1
1Department Infectious Diseases, Hôpital Rothschild, Paris, France; 2Department of Rheumatology, Inserm U349, Paris, France; and 3Laboratory of Endocrinian Biology, Hôpital Lariboisière, Paris, France
BACKGROUND: Osteopenia has been recently associated with antiretroviral therapy (ART) but the relation between osteoporosis/osteopenia, ART, lipodystrophy, hyperlipidemia and other factors is not well established.
OBJECTIVE: This study was performed to evaluate the frequency of osteoporosis/osteopenia in HIV-positive males treated with protease inhibitor (PI), with nucleoside reverse transcriptase inhibitors (NRTIs) alone, or untreated, and to correlate these data with lipodystrophy and with markers of bone metabolism.
METHODS: This comparative study concerned HIV-positive male (25-55 years old) treated with the same classes of ART for ≥18 months (group A with PI; group B with no PI - B1, 2 NRTI + 1 non-nucleoside reverse transcriptase inhibitor; and B2, 3 NRTI); or group C, untreated). One-hundred-and-fifty patients had to be included. Judgment criteria were bone mineral density (BMD) measured by DEXA at three sites (femoral neck, trochanter, lumbar spine), fractures, clinical signs of lipodystrophy, markers of glucidolipidic, hormonal and bone metabolism and habitus.
RESULTS: Data are currently available for 119/150 patients (n=47, 23, 23, 25 for groups A, B1, B2, C). For the whole HIV-positive population, frequency of osteoporosis was 7-11% and of osteopenia was 44-55% according to the site of measurement. The mean Z-score (SD compared to a referenced age and sex matched population) was below 0 in each group of patients. The Z-score (mean±SD) of the whole HIV-positive population was -1.12±1.17 at the lumbar spine and -0.46±0.99 at the femoral neck. Lipodystrophy was frequent in groups A (89%) and B (74% with predominant atrophic forms) compared to group C (4%) (P<0.001).
CONCLUSIONS: In HIV-infected population, osteoporosis/ osteopenia is frequent and BMD is decreased, even in untreated patients. Relationship between BMD and lipodystrophy or bone metabolism markers is currently assessed in our study as well as the possible difference in bone status according to the treatments.
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