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Shiau S, Zumpano F, Wang Z, Shah J, Tien PC, Ross RD, Sharma A, Yin MT. Epigenetic Aging and Musculoskeletal Outcomes in a Cohort of Women Living With HIV. J Infect Dis 2024; 229:1803-1811. [PMID: 38366369 PMCID: PMC11175700 DOI: 10.1093/infdis/jiae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The relationship between accelerated epigenetic aging and musculoskeletal outcomes in women with HIV (WWH) has not been studied. METHODS We measured DNA methylation age using the Infinium MethylationEPIC BeadChip in a cohort from the Women's Interagency HIV Study (n = 190) with measures of bone mineral density (BMD) and physical function. We estimated 6 biomarkers of epigenetic aging-epigenetic age acceleration (EAA), extrinsic EAA, intrinsic EAA, GrimAge, PhenoAge, and DNA methylation-estimated telomere length-and evaluated associations of epigenetic aging measures with BMD and physical function. We also performed epigenome-wide association studies to examine associations of DNA methylation signatures with BMD and physical function. RESULTS This study included 118 WWH (mean age, 49.7 years; 69% Black) and 72 without HIV (mean age, 48.9 years; 69% Black). WWH had higher EAA (mean ± SD, 1.44 ± 5.36 vs -1.88 ± 5.07; P < .001) and lower DNA methylation-estimated telomere length (7.13 ± 0.31 vs 7.34 ± 0.23, P < .001) than women without HIV. There were no significant associations between accelerated epigenetic aging and BMD. Rather, measures of accelerated epigenetic aging were associated with lower physical function. CONCLUSIONS Accelerated epigenetic aging was observed in WWH as compared with women without HIV and was associated with lower physical function in both groups.
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Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Francesca Zumpano
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Ziyi Wang
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Jayesh Shah
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Phyllis C Tien
- Department of Medicine, Veterans Affairs Medical Center
- Department of Medicine, University of California San Francisco
| | - Ryan D Ross
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Michael T Yin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
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Gehrke B, Farias MLF, Wildemberg LE, Ferraiuoli GI, Ribeiro V, Bosgnoli R, Paranhos Neto FDP, de Mendonça LMC, Madeira M, Coelho MCA. Evaluation of bone mineral density, microarchitecture, and detection of fractures on young patients living with human immunodeficiency virus: when and how to screen? Endocrine 2024; 83:214-226. [PMID: 37673836 DOI: 10.1007/s12020-023-03501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE People living with the human immunodeficiency virus (PLWH) developed higher life expectancy along with chronic bone disease over the past years. Our purpose is to evaluate bone mineral density, bone microarchitecture and fractures in young PLWH and understand the disease's contribution to bone derangements and fracture risk. METHODS Eighty-one HIV-infected and 54 control young (20-50 years) male and female subjects were enrolled in this study. Methods for patient evaluation included DXA-VFA (dual energy X-rays and vertebral fracture assessment), HR-pQCT (high resolution peripheral quantitative computed tomography), biochemistry and FRAX. RESULTS Fifty participants from each group completed all exams. Median age was 40 (25-49) vs. 36.5 (22-50) for the HIV and control groups, respectively (p 0.120). Ethnicity, body mass index, serum phosphorus, 25-hydroxyvitamin D, PTH and CTX were similar between groups, although ALP and OC suggested higher bone turnover in PLWH. VFA identified morphometric vertebral fractures in 12% of PLWH. PLWH had lower values for lumbar spine areal BMD and Z score, volumetric BMD, trabecular bone fraction (BV/TV) and trabecular number measured at the distal tibia by HR-pQCT; as a consequence, trabecular separation and heterogeneity were higher (all p < 0.05). The FRAX-estimated risk for hip and major osteoporotic fractures was statistically higher in PLWH (p < 0.001). CONCLUSION Our results confirm severe bone impairment and fractures associated with HIV in young patients. Thus, we developed a screening protocol for young PLWH to detect bone fragility, reduce skeletal disease progression and morbimortality, decrease fracture risk, and increase quality of life.
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Affiliation(s)
- Bárbara Gehrke
- Programa de Pós-graduação em Fisiopatologia Clínica e Experimental (FISCLINEX) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil.
- Centro de Pesquisa Clínica Multiusuário (CePeM) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil.
- Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, 20550-900, RJ, Brasil.
| | - Maria Lucia Fleiuss Farias
- Divisão de Endocrinologia - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil
| | - Luiz Eduardo Wildemberg
- Divisão de Neuroendocrinologia - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, 20231-092, RJ, Brasil
| | - Giovanna Ianini Ferraiuoli
- Divisão de Infectologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil
| | - Valéria Ribeiro
- Divisão de Infectologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil
| | - Rogério Bosgnoli
- Labhor - Laboratório de Hormônios da Endocrinologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil
| | | | - Laura Maria Carvalho de Mendonça
- Divisão de Reumatologia, Departamento de Medicina Interna - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil
| | - Miguel Madeira
- Divisão de Endocrinologia - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil
| | - Maria Caroline Alves Coelho
- Programa de Pós-graduação em Fisiopatologia Clínica e Experimental (FISCLINEX) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil
- Centro de Pesquisa Clínica Multiusuário (CePeM) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil
- Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, 20550-900, RJ, Brasil
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Milic J, Renzetti S, Morini D, Motta F, Carli F, Menozzi M, Cuomo G, Mancini G, Simion M, Romani F, Spadoni A, Baldisserotto I, Barp N, Diazzi C, Mussi C, Mussini C, Rochira V, Calza S, Guaraldi G. Bone Mineral Density and Trabecular Bone Score Changes throughout Menopause in Women with HIV. Viruses 2023; 15:2375. [PMID: 38140615 PMCID: PMC10747369 DOI: 10.3390/v15122375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE The objectives of this study were to describe the trajectories of bone mineral density (BMD) and trabecular bone score (TBS) changes throughout pre-menopause (reproductive phase and menopausal transition) and post-menopause (early and late menopause) in women with HIV (WWH) undergoing different antiretroviral therapies (ARTs) and explore the risk factors associated with those changes. METHODS This was an observational longitudinal retrospective study in WWH with a minimum of two DEXA evaluations comprising BMD and TBS measurements, both in the pre-menopausal and post-menopausal periods. Menopause was determined according to the STRAW+10 criteria, comprising four periods: the reproductive period, menopausal transition, and early- and late-menopausal periods. Mixed-effects models were fitted to estimate the trajectories of the two outcomes (BMD and TBS) over time. Annualized lumbar BMD and TBS absolute and percentage changes were calculated in each STRAW+10 time window. A backward elimination procedure was applied to obtain the final model, including the predictors that affected the trajectories of BMD or TBS over time. RESULTS A total of 202 WWH, all Caucasian, were included. In detail, 1954 BMD and 195 TBS data were analyzed. The median number of DEXA evaluations per woman was 10 (IQR: 7, 12). The median observation periods per patient were 12.0 years (IQR = 8.9-14.4) for BMD and 6.0 years (IQR: 4.3, 7.9) for TBS. The prevalence of osteopenia (63% vs. 76%; p < 0.001) and osteoporosis (16% vs. 36%; p < 0.001) increased significantly between the pre-menopausal and post-menopausal periods. Both BMD (1.03 (±0.14) vs. 0.92 (±0.12) g/cm2; p < 0.001) and TBS (1.41 (IQR: 1.35, 1.45) vs. 1.32 (IQR: 1.28, 1.39); p < 0.001) decreased significantly between the two periods. The trend in BMD decreased across the four STRAW+10 periods, with a slight attenuation only in the late-menopausal period when compared with the other intervals. The TBS slope did not significantly change throughout menopause. The delta mean values of TBS in WWH were lower between the menopausal transition and reproductive period compared with the difference between menopause and menopausal transition. CONCLUSIONS Both BMD and TBS significantly decreased over time. The slope of the change in BMD and TBS significantly decreased in the menopausal transition, suggesting that this period should be considered by clinicians as a key time during which to assess bone health and modifiable risk factors in WWH.
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Affiliation(s)
- Jovana Milic
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Denise Morini
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84121 Salerno, Italy;
| | - Federico Motta
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
| | - Federica Carli
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Giuseppe Mancini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Mattia Simion
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Federico Romani
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Anna Spadoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Irene Baldisserotto
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Nicole Barp
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Chiara Diazzi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (C.D.); (V.R.)
| | - Chiara Mussi
- Department of Biomedical and Metabolic Sciences and Neuroscience, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (C.D.); (V.R.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, 41126 Modena, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
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Greene M, Shi Y, Boscardin J, Sudore R, Gandhi M, Covinsky K. Geriatric conditions and healthcare utilisation in older adults living with HIV. Age Ageing 2022; 51:6577097. [PMID: 35511728 PMCID: PMC9271234 DOI: 10.1093/ageing/afac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND older HIV-positive adults experience a significant burden of geriatric conditions. However, little is known about the association between geriatric conditions and healthcare utilisation in this population. SETTING outpatient safety-net HIV clinic in San Francisco. METHODS in 2013, HIV-positive adults ≥50 years of age underwent geriatric assessment including functional impairment, fall(s)in past year, cognitive impairment (MOCA <26) and low social support (Lubben social network scale ≤12). We reviewed medical records from 2013 through 2017 to capture healthcare utilisation (emergency room (ER) visits and hospitalisations) and used Poisson models to examine the association between geriatric conditions and utilisation events over 4 years. RESULTS among 192 participants, 81% were male, 51% were white, the median age was 56 (range 50-74), and the median CD4 count was 508 (IQR 338-688) cells/mm3. Sixteen percent of participants had ≥1 activities of daily living (ADL) dependency, 58% had ≥1 instrumental activities of daily living IADL dependency, 43% reported ≥1 falls, 31% had cognitive impairment, and 58% had low social support. Over 4 years, 90 participants (46%) had ≥1 ER visit (total of 289 ER visits), 39 (20%) had ≥1 hospitalisation (total of 68 hospitalisations), and 15 (8%) died. In unadjusted and adjusted analyses, IADL dependency and falls were associated with healthcare utilisation (adjusted incidence rate ratios IADL (95%CI): 1.73 (1.33-2.25); falls: 1.51 (1.21-1.87)). CONCLUSION IADL dependency and history of falls were associated with healthcare utilisation among older HIV-positive adults. Although our results are limited by sample size, improved understanding of the association between geriatric conditions and healthcare utilisation could build support for geriatric HIV care models.
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Affiliation(s)
- Meredith Greene
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,Address correspondence to: Meredith Greene, 490 Illinois Street, Floor 08 San Francisco, CA 94143, USA. Tel: 415-502-3626;
| | - Ying Shi
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - John Boscardin
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Rebecca Sudore
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth Covinsky
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Wilkinson M, Biernacki P, Knestrick J. HIV in Primary Care: Case Study of Common Chronic Comorbidities. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Andrade LBD, Nogueira TF, Vargas DM. Height adjustment reduces occurrence of low bone mineral density in children and adolescents with HIV. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1240-1245. [PMID: 34816914 DOI: 10.1590/1806-9282.20210137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the reduction of bone mineral density with and without height adjustment. METHODS A cross-sectional study was performed with 69 Brazilian children and adolescents vertically infected by HIV. Bone mineral density was measured by dual-energy absorptiometry in the lumbar spine. Anthropometric, demographic, and clinical variables were analyzed. A specific calculator was used for height adjustment. RESULTS The majority of participants (52.2%) were adolescents and did not present with immunological alterations (61%). Reduced bone mineral density (Z-score <-1) was present in 23.2% and low bone mass (Z-score <-2) in 5.8%. After height adjustment, these occurrences decreased to 11.6% and 0%, respectively. Patients with reduced bone mineral density had a higher mean age and lower body mass index than patients with normal bone mineral density. CONCLUSION The occurrence of reduced bone mineral density decreased after adjustment for height.
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Affiliation(s)
| | - Thiago Fachini Nogueira
- Universidade de Blumenau, Centro de Ciências de Saúde, Departamento de Medicina - Blumenau (SC), Brazil
| | - Deisi Maria Vargas
- Universidade de Blumenau, Centro de Ciências de Saúde, Departamento de Medicina e Programa de Pós-graduação em Saúde Coletiva - Blumenau (SC), Brazil
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Boontanondha P, Nimitphong H, Musikarat S, Ragkho A, Kiertiburanakul S. Vitamin D and Calcium Supplement Attenuate Bone Loss among HIVInfected Patients Receiving Tenofovir Disoproxil Fumarate/Emtricitabine/ Efavirenz: An Open-Label, Randomized Controlled Trial. Curr HIV Res 2021; 18:52-62. [PMID: 31906840 PMCID: PMC7516332 DOI: 10.2174/1570162x18666200106150806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART), especially with tenofovir disoproxil fumarate (TDF), has been associated with accelerated bone turnover and leads to significant bone loss. OBJECTIVE We aimed to determine the effect of vitamin D2 and calcium on bone mineral density (BMD) in HIV-infected patients receiving TDF/emtricitabine (FTC)/efavirenz (EFV). METHODS A prospective, open-label, randomized controlled study was conducted. Eligible patients were ART naïve HIV individuals who initiated TDF/FTC/EFV. The study group received supplementation with vitamin D2 and calcium carbonate, whereas the control group was administered only ART. The primary outcome was the percentage change in total hip BMD at week 24 compared with baseline. RESULTS A total of 18 patients were randomized (9 in each group). The mean (standard deviation; SD) total hip BMD significantly decreased from baseline in both groups, from 0.96 (0.14) g/cm2 to 0.93 (0.13) g/cm2 in the study group (p = 0.006) and from 0.87 (0.11) g/cm2 to 0.84 (0.11) g/cm2 in the control group (p = 0.004). The mean (SD) lumbar spine BMD significantly decreased from baseline in both groups, from 1.00 (0.13) g/cm2 to 0.97 (0.13) g/cm2 (p = 0.004) in the study group and from 0.90 (0.09) g/cm3 to 0.86 (0.08) g/cm2 in the control group (p = 0.006). At week 24, the mean (SD) lumbar spine BMD was significantly greater in the study group than in the control group (p = 0.042). However, there were no significant differences in the percentage change of total hip, lumbar spine, and femoral neck BMD between both groups. No adverse events were reported. In conclusion, as early as 24 weeks after TDF initiation, a significant decline in BMD was detected. CONCLUSION Vitamin D2 and calcium supplements should be considered for HIV-infected patients receiving TDF/FTC/EFV in a resource-limited setting where there are limited ART options (Clinicaltrials. gov NCT0287643).
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Affiliation(s)
- Patawee Boontanondha
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Hataikarn Nimitphong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Suchawadee Musikarat
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Aschara Ragkho
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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Pornpaisalsakul K, Songtaweesin WN, Tepmongkol S, Wongharn P, Kawichai S, Suponsilchai V, Anugulruengkitt S, Puthanakit T. Effects of vitamin D and calcium supplementation on bone mineral density among Thai youth using daily HIV pre-exposure prophylaxis. J Int AIDS Soc 2021; 23:e25624. [PMID: 33040465 PMCID: PMC7548100 DOI: 10.1002/jia2.25624] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Tenofovir disoproxil fumarate with emtricitabine (TDF/FTC) is used for HIV pre-exposure prophylaxis (PrEP). TDF may affect bone mineral density (BMD), particularly in youth who are at a stage of peak bone mass accrual. The objective of this study was to evaluate the effect of vitamin D and calcium supplementation on BMD among Thai youth receiving daily oral PrEP. METHODS This open-label randomized trial was conducted in male youth aged between 15 and 24 years. Participants were randomized to Arm A who received once-daily TDF/FTC plus vitamin D3 and calcium supplementation with meals twice daily (400 units of vitamin D3 and 1200 mg of elemental calcium/day) or Arm B who received once-daily TDF/FTC only. PrEP users were defined as taking at least two tablets/week (tenofovir-diphosphate level of >350 fmol/punch). Adherence to vitamin D/calcium supplementation was defined as self-reported adherence of >50%. Lumbar spine (L2-L4) BMD (LSBMD) was evaluated by dual-energy X-ray absorptiometry scan zero and six months after PrEP initiation. RESULTS From March 2019 to March 2020, 100 youth were enrolled. Baseline characteristics between the two arms were similar. Median (IQR) age was 18 (17 to 20) years. At entry, median (IQR) LSBMD z-score was -0.8 (-1.5 to -0.3), 17% had low LSBMD (Z-score < -2). The median amount of calcium intake from nutritional three-day recall was 167 (IQR 94 to 272) mg/day, 39% of participants had vitamin D deficiency, defined as 25(OH)D levels <20 IU/mL. At six months, 79 participants were evaluated. Of these, 42 (52%) were PrEP takers and 25 of 38 (66%) of arm A participants had good adherence to vitamin D/calcium supplementation. Significantly higher proportions of youth in arm A compared to arm B had >3% increase in LSBMD at month 6 compared to baseline (67.6% vs. 42.9% respectively; p = 0.03). There were significantly higher increases in LSBMD among youth with vitamin D deficiency who were supplemented; arm A + 0.05 (0 to 0.05) compared to arm B + 0.03 (-0.1 to 0.03), p = 0.04. CONCLUSIONS Increases in LSBMD over six months among youth using PrEP who received vitamin D/calcium supplementation was greater than those not supplemented. Long-term follow-up should be considered to explore long-term outcomes.
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Affiliation(s)
- Krittaporn Pornpaisalsakul
- Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wipaporn Natalie Songtaweesin
- Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supatporn Tepmongkol
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Chulalongkorn University Biomedical Imaging Group, Faculty of Medicine, Chulalongkorn University
| | - Prissana Wongharn
- Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Surinda Kawichai
- Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vichit Suponsilchai
- Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Endocrinology, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suvaporn Anugulruengkitt
- Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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9
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Lemma M, Petkov S, Bekele Y, Petros B, Howe R, Chiodi F. Profiling of Inflammatory Proteins in Plasma of HIV-1-Infected Children Receiving Antiretroviral Therapy. Proteomes 2020; 8:proteomes8030024. [PMID: 32906648 PMCID: PMC7563605 DOI: 10.3390/proteomes8030024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022] Open
Abstract
Treatment of HIV-1-infected patients results in improved clinical and immunological conditions, but severe non-AIDS-related conditions still persist. Novel proteomic platforms have identified inflammatory proteins where abundance is dysregulated in adult treated patients, whereas limited data are available in treated HIV-1 infection of children. Using a proteomic plasma profiling approach comprising 92 inflammation-related molecules, we analyzed specimens from 43 vertically HIV-1-infected children receiving antiretroviral treatment (ART) and matched controls in Ethiopia. The infected children were analyzed as a group and separately, according to age of treatment initiation. Proteins displaying a significantly different abundance between groups were hierarchically clustered and presented in heat maps. Random forest analysis was performed to pin-point proteins discriminating between groups; five proteins (STAMBP, CD5, TFG-α, TRANCE, AXIN1) were the strongest prediction factors for treated HIV-1 infection. TRANCE was previously linked to reduced bone mass levels in HIV-1-infected children. CCL4 chemokine, ligand to HIV-1 co-receptor CCR5, was the most critical protein for successful classification between children who initiated ART at different time points. Our data provide evidence that a dysregulated expression of proteins linked to immunological abnormalities and bone metabolism can be found in HIV-1-infected children with prolonged exposure to ART.
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Affiliation(s)
- Mahlet Lemma
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 171 65 Solna, Sweden; (M.L.); (S.P.); (Y.B.)
- Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia;
- Department of Microbial, Cellular and Molecular Biology, PO Box 1176, Addis Ababa University, Addis Ababa, Ethiopia;
| | - Stefan Petkov
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 171 65 Solna, Sweden; (M.L.); (S.P.); (Y.B.)
| | - Yonas Bekele
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 171 65 Solna, Sweden; (M.L.); (S.P.); (Y.B.)
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, PO Box 1176, Addis Ababa University, Addis Ababa, Ethiopia;
| | - Rawleigh Howe
- Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia;
| | - Francesca Chiodi
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 171 65 Solna, Sweden; (M.L.); (S.P.); (Y.B.)
- Correspondence: ; Tel.: +46-8-52486315
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10
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Iwamoto SJ, Rothman MS, Duan S, Baker JC, Mumm S, Whyte MP. Early-onset Paget's disease of bone in a Mexican family caused by a novel tandem duplication (77dup27) in TNFRSF11A that encodes RANK. Bone 2020; 133:115224. [PMID: 31923705 PMCID: PMC7179970 DOI: 10.1016/j.bone.2020.115224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 02/07/2023]
Abstract
Four heterozygous in-frame tandem duplications of different lengths in TNFRSF11A, the gene that encodes receptor activator of nuclear factor κB (RANK), constitutively activate RANK and lead to high turnover skeletal disease. Each duplication elongates the signal peptide of RANK. The 18-base pair (bp) duplication at position 84 (84dup18) causes familial expansile osteolysis (FEO), the 15-bp duplication at position 84 (84dup15) causes expansile skeletal hyperphosphatasia (ESH), the 12-bp duplication at position 90 (90dup12) causes panostotic expansile bone disease (PEBD), and the 27-bp duplication causes early-onset Paget's disease of bone (PDB2). The severity of the associated skeletal disease seems inversely related to the duplication's length. Additional 15- and 18-bp duplications of TNFRSF11A fit this pattern. Herein, we delineate the skeletal disease of a middle-aged man of Mexican descent who we found to harbor a novel 27-bp tandem duplication at position 77 (77dup27) of TNFRSF11A. His disorder shares features, particularly hand involvement, with the single Japanese (75dup27) and Chinese (78dup27) kindreds with PDB2 (PDB2Jpn and PDB2Chn, respectively). However, his distinct hearing loss developed later in adulthood compared to the other 27-bp families. He reported no morbidities during childhood, but in his late 20s developed unexplained tooth loss, low-trauma fractures, post-operative hypercalcemia, and painless enlargement of his fingers. Biochemical studies showed elevated serum alkaline phosphatase (ALP), bone-specific ALP, C-telopeptide, and osteocalcin consistent with rapid bone remodeling. Radiologic imaging revealed remarkably lucent bones with vertebral compression fractures, calvarial lucencies, and thinned long bone cortices. DXA showed extremely low bone mineral density. His disorder genetically and phenotypically fits best with PDB2 and can be called PDB2Mex.
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Affiliation(s)
- Sean J Iwamoto
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA; Division of Endocrinology, Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, CO, USA.
| | - Micol S Rothman
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Shenghui Duan
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.
| | - Jonathan C Baker
- Musculoskeletal Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Steven Mumm
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA; Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children-St. Louis, St. Louis, MO, USA.
| | - Michael P Whyte
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA; Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children-St. Louis, St. Louis, MO, USA.
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11
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Spinelli MA, Glidden DV, Anderson PL, Gandhi M, McMahan VM, Defechereux P, Schechter M, Veloso VG, Chariyalertsak S, Guanira JV, Bekker LG, Buchbinder SP, Grant RM. Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project. AIDS Res Hum Retroviruses 2019; 35:788-793. [PMID: 31119944 PMCID: PMC6735322 DOI: 10.1089/aid.2018.0297] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Bone mineral density (BMD) declines due to tenofovir-containing pre-exposure prophylaxis (PrEP) have varied among PrEP demonstration projects, potentially related to variable adherence. Characterization of BMD changes in highly adherent individuals, estimated via tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS), can assist clinicians when counseling patients. Cisgender men who have sex with men and transwomen in the optional dual-energy X-ray absorptiometry (DXA) substudy of a large, international, open-label PrEP demonstration project, the iPrEx-open-label extension (OLE) study underwent DXA scans and DBS collection every 24 weeks, with average weekly dosing adherence patterns (2, 4, and 7 doses/week) estimated from validated TFV-DP cut-offs. The mean percent BMD change was estimated in strata of average weekly adherence by using a linear mixed-effects model to calculate the BMD decline in highly adherent individuals on PrEP for the first time. DXA/DBS data were available for 254 individuals over a median of 24 weeks in iPrEx-OLE from June 2011 to December 2013. The percent decline in spine BMD was monotonically associated with strata of increasing average weekly adherence (p < .001 trend); the p value for trends using hip BMD measurements was .07. Individuals with estimated daily adherence experienced a 1.2% decrease in spine BMD and a 0.5% drop in hip BMD. In highly adherent PrEP users, we found a lower-than-expected drop in BMD when compared with previous studies. This drop is likely not clinically significant for most PrEP users. However, for those at the highest risk of fracture who plan prolonged PrEP use, alternate PrEP strategies could be considered.
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Affiliation(s)
- Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California
| | - Vanessa M. McMahan
- Department of Health Services, University of Washington, Seattle, Washington
| | - Patricia Defechereux
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Mauro Schechter
- Department of Preventive Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valdiléa G. Veloso
- Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences and Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Susan P. Buchbinder
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Robert M. Grant
- Department of Medicine, University of California, San Francisco, San Francisco, California
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12
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Zaid D, Greenman Y. Human Immunodeficiency Virus Infection and the Endocrine System. Endocrinol Metab (Seoul) 2019; 34:95-105. [PMID: 31257738 PMCID: PMC6599897 DOI: 10.3803/enm.2019.34.2.95] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 12/29/2022] Open
Abstract
In the current era of effective antiretroviral therapies (ARTs), human immunodeficiency virus (HIV) infection became a chronic disorder that requires long term follow-up. Among other medical issues, these patients may develop endocrine problems, specific to HIV infection and its treatment. The purpose of this review is to give an overview of common endocrine complications associated with HIV infection, and to propose diagnostic and therapeutic strategies. HIV can affect the endocrine system at several levels. Adrenal and gonadal dysfunction, osteoporosis with increased fracture risk, dyslipidemia with increased cardiovascular risk, are some of the endocrine disorders prevalent in HIV-infected patients that may negatively influence quality of life, and increase morbidity and mortality. While ARTs have dramatically increased life expectancy in the HIV-infected population, they are not devoid of adverse effects, including endocrine dysfunction. Physicians caring for HIV-infected patients should be knowledgeable and exercise a high index of suspicion for the diagnosis of endocrine abnormalities, and in particular be aware of those that can be life threatening. Endocrine evaluation should follow the same strategies as in the general population, including prevention, early detection, and treatment.
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Affiliation(s)
- Dana Zaid
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Bone Mineral Density Declines Twice as Quickly Among HIV-Infected Women Compared With Men. J Acquir Immune Defic Syndr 2019; 77:288-294. [PMID: 29140875 DOI: 10.1097/qai.0000000000001591] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Initial declines in bone mineral density (BMD) after antiretroviral therapy initiation in HIV are well described, but data on long-term changes and risk factors for decline, particularly among women, are limited. METHODS HIV-infected men and women in the Modena Metabolic Clinic underwent dual-energy X-ray absorptiometry (DXA) scans every 6-12 months for up to 10 years (median 4.6 years). Mixed effect regression models in combined and sex-stratified models determined annual rates of decline and clinical factors associated with BMD. Models included demographics, HIV-specific factors, and bone-specific factors; a final model added a sex × time interaction term. RESULTS A total of 839 women and 1759 men contributed ≥2 DXA scans. The majority (82%) were 50 years and younger; 76% had HIV-1 RNA <50 copies per milliliter at baseline; 15% of women were postmenopausal and 7% of men had hypogonadism; and 30% and 27%, respectively, had hepatitis C virus (HCV) coinfection. The adjusted slopes in BMD among women and men were significantly different at both the femoral neck (women -0.00897 versus men -0.00422 g/cm per year; P < 0.001) and L-spine (women -0.0127 versus men -0.00763 g/cm per year; P < 0.001). Modifiable risks associated with BMD decline included antiretroviral therapy exposure (greater decline with tenofovir disoproxil fumarate and less decline with integrase strand transfer inhibitor therapy), HCV, physical activity, and vitamin D insufficiency. CONCLUSIONS Among HIV-infected individuals, bone density at the femoral neck, a significant predictor of fracture risk, declined twice as quickly among women compared with men. Female sex was independently associated with both lower femoral neck and lumbar BMD over time in adjusted models.
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14
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Monthly or Weekly Supplementation with Cholecalciferol 20,000 IU in People Living with HIV: Results from a Nested Cohort Study. Interdiscip Perspect Infect Dis 2018; 2018:7502127. [PMID: 30245713 PMCID: PMC6139192 DOI: 10.1155/2018/7502127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/28/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022] Open
Abstract
Background There is still considerable uncertainty in handling vitamin D deficiency in people living with HIV (PLWH), due to a lack of comparative data and the wide range of recommended daily intake. Nondaily supplementation might be preferred in many PLWH, but recommendation on dosing has not been established. We aimed to compare the efficacy of weekly versus monthly supplementation with cholecalciferol 20,000 IU in a group of PLWH with vitamin D deficiency in Western Europe. Study Design Longitudinal, retrospective nested cohort study of PLWH from two large clinical care centers in Munich, Germany. Results Of 307 patients with vitamin D deficiency, 124 patients received vitamin D supplementation (weekly supplementation in 84 (67.7%)). 46.4% and 22.5% of patients achieved 25(OH)D levels ≥30 ng/mL after 12 months of weekly and monthly supplementation with cholecalciferol 20,000 IU, respectively (p=0.011). Dosing interval as well as 25(OH)D baseline levels >15 ng/mL were associated with the normalization of 25(OH)D. Conclusion A higher rate of 25(OH)D level normalization can be achieved via weekly supplementation. For several PLWH, even a weekly dose of cholecalciferol 20,000 IU might not be adequate to maintain 25(OH)D levels >30 ng/mL without an initial "loading" dose. The response to supplementation is poorly predictable at an individual level.
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15
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Mata-Marín JA, Arroyo-Anduiza CI, Berrospe-Silva MDLÁ, Chaparro-Sánchez A, Gil-Avila A, Gaytán-Martínez J. Mexican patients with HIV have a high prevalence of vertebral fractures. Infect Dis Rep 2018; 10:7409. [PMID: 29721240 PMCID: PMC5907732 DOI: 10.4081/idr.2018.7409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 01/26/2018] [Indexed: 02/06/2023] Open
Abstract
Low bone mineral density (BMD) and fragility fractures are common in individuals infected with HIV, who are undergoing antiretroviral therapy (ART). In high-income countries, dual energy X-ray absorptiometrry is typically used to evaluate osteopenia or osteoporosis in HIV infected individuals. However, this technology is unavailable in low andmiddle income countries, so a different approach is needed. The aim of this study was to use X-ray scans of the spine to determine the prevalence of and associated risk factors for vertebral fractures in HIVinfected patients in a tertiary-care hospital in Mexico. We conducted a cross-sectional study of outpatients who were >40 years old and receiving ART at the Hospital de Infectología, La Raza National Medical Center in Mexico City, Mexico. We used semi-quantitative morphometric analysis of centrally digitized X-ray images to assess vertebral deformities in the spine. Anterior, middle and posterior vertebral heights were measured, and height ratios were calculated. For each vertebral body, fractures were graded on the basis of height ratio reductions, and a spine deformity index’ (SDI) value was calculated by summing the grades of the vertebral deformities: An SDI>1 was indicative of a vertebral fracture. We included 104 patients, 87% of whom were men. The median age was 49 years [interquartile range (IQR) 42-52]. The most common stage of HIV infection, as defined by the Centers for Disease Control, was B2 in 40 (39%) of patients. Forty seven (45%) patients were on ART regimens that included protease inhibitors (PIs) and 100 (96%) being treated with tenofovir. The median time of ART was 6.5 years (IQR 1.6-9.0). Of the 104 patients in our study, 83 (80%) had undetectable viral load, as assessed by HIV-1 RNA levels, 32 (31%) showed evidence of a previous fracture, 4 (4%) were co-infected with hepatitis C virus, and 57 (55%) had a history of corticosteroid treatment. The prevalence of vertebral fractures was 25%, 95% confidence interval 17-34%. We assessed whether gender, HCV co-infection, previous corticosteroid use, AIDS, total HIV viral load, and current and previous use of PIs were associated with fractures in our study group, but we did not observe a significant association between any of these factors and vertebral fractures. The prevalence of vertebral fractures was high among HIV-infected patients. We propose that screening for bone disease should be performed in HIV individuals who are at risk of fragility fractures. Furthermore, we suggest that X-ray based assessment of the spine should be considered in patients who are at increased risk of fragility fractures, irrespective of BMD levels, particularly in elderly patients in low and middle income countries.
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Affiliation(s)
- José Antonio Mata-Marín
- Infectious Diseases Department, Hospital de Infectología, La Raza National Medical Center, Mexico City
| | - Carla I Arroyo-Anduiza
- Clinical Pathology Department, Central Blood Bank, La Raza National Medical Center, Mexico City
| | | | - Alberto Chaparro-Sánchez
- Infectious Diseases Department, Hospital de Infectología, La Raza National Medical Center, Mexico City
| | - Ana Gil-Avila
- Imagenology Department, Hospital de Infectología, La Raza National Medical Center, Mexico City, Mexico
| | - Jesús Gaytán-Martínez
- Infectious Diseases Department, Hospital de Infectología, La Raza National Medical Center, Mexico City
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16
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Shiau S, Yin MT, Strehlau R, Patel F, Mbete N, Kuhn L, Coovadia A, Arpadi SM. Decreased bone turnover in HIV-infected children on antiretroviral therapy. Arch Osteoporos 2018; 13:40. [PMID: 29623447 PMCID: PMC5886991 DOI: 10.1007/s11657-018-0452-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/25/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED In this study, we evaluated the relationships between immune activation, bone turnover, and bone mass in virally suppressed HIV-infected children and HIV-uninfected children in South Africa. We found that decreased bone mass may occur or persist independent of immune activation and altered bone turnover. PURPOSE HIV-infected children and adolescents have deficits in skeletal growth which include decreases in bone mass and alterations in bone microarchitecture. However, the mechanism by which HIV infection compromises bone accrual in children and adolescents is unclear. The goal of this study was to evaluate the relationships between immune activation, bone turnover, and bone mass in a group of pre-pubertal HIV-infected children randomized to remain on ritonavir-boosted lopinavir (LPV/r)-based antiretroviral therapy (ART) or switch to efavirenz-based ART in South Africa virally suppressed at the time of this study. METHODS This cross-sectional analysis included 219 HIV-infected and 180 HIV-uninfected children enrolled in the CHANGES Bone Study conducted in Johannesburg, South Africa. Whole body (WB) bone mineral content (BMC) was assessed by dual x-ray absorptiometry and WB BMC Z-scores adjusted for sex, age, and height were generated. Bone turnover markers, including C-telopeptide of type 1 collagen (CTx) and procollagen type I N-terminal propeptide (P1NP), were analyzed. Markers of immune activation were also measured, including cytokines IL-6 and TNF-alpha, as well as soluble CD14 and high-sensitivity C-reactive protein (CRP). RESULTS Compared to uninfected controls, HIV-infected children had lower WB BMC Z-scores, similar IL-6 and TNF-alpha, higher soluble CD14 and high-sensitivity CRP, and lower markers of bone resorption (CTX) and bone formation (P1NP). Bone turnover markers were not different in those remaining on LPV/r or switched to efavirenz. CONCLUSIONS Our findings suggest that in HIV-infected children with viral suppression, decreased bone accrual may occur or persist independent of immune activation and altered bone turnover.
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Affiliation(s)
- Stephanie Shiau
- 0000000419368729grid.21729.3fGertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, PH 19-114, New York, NY 10032 USA ,0000000419368729grid.21729.3fDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA ,0000 0004 1937 1135grid.11951.3dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael T. Yin
- 0000000419368729grid.21729.3fDepartment of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Renate Strehlau
- 0000 0004 1937 1135grid.11951.3dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- 0000 0004 1937 1135grid.11951.3dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ndileka Mbete
- 0000 0004 1937 1135grid.11951.3dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- 0000000419368729grid.21729.3fGertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, PH 19-114, New York, NY 10032 USA ,0000000419368729grid.21729.3fDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA ,0000 0004 1937 1135grid.11951.3dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashraf Coovadia
- 0000 0004 1937 1135grid.11951.3dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M. Arpadi
- 0000000419368729grid.21729.3fGertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, PH 19-114, New York, NY 10032 USA ,0000000419368729grid.21729.3fDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA ,0000 0004 1937 1135grid.11951.3dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ,0000000419368729grid.21729.3fDepartment of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY USA
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17
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Bayard C, Ledergerber B, Flepp M, Lecompte T, Moulin E, Hoffmann M, Weber R, Staehelin C, Di Benedetto C, Fux CA, Tarr PE, Hasse B. Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study. Open Forum Infect Dis 2017; 4:ofx177. [PMID: 29026869 PMCID: PMC5632527 DOI: 10.1093/ofid/ofx177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/12/2017] [Indexed: 11/30/2022] Open
Abstract
Background HIV-infected individuals have an increased risk of avascular bone necrosis (AVN). Antiretroviral therapy (ART) and particularly protease inhibitors (PI) have been implicated as a risk factor. We aimed to study the associations of ART with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS). Methods We used incidence density sampling to perform a case control study within the Swiss HIV Cohort Study (SHCS) comparing prospectively collected AVN cases and controls by conditional logistic regression analysis. To evaluate the effect of ART, multivariable models were adjusted for HIV transmission risk group, age, alcohol consumption, use of corticosteroids, CD4 nadir, maximum viral load, and pancreatitis. Results We compared 74 AVN cases and 145 controls. Associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1–10), alcohol consumption (OR, 2.7; 95% CI, 1.3–5.7), and hyperlipidemia (OR, 3.6; 95% CI, 1.4–9.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4; 95% CI, 1.4–14) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN. Conclusions In the HIV-infected population, a combination of risk factors such as heterosexual HIV acquisition, moderate to severe alcohol intake, and hyperlipidemia seem to contribute to AVN. ART does not seem to be a relevant risk factor for AVN. The association of prolonged TDF exposure with AVN needs to be confirmed.
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Affiliation(s)
- Cornelia Bayard
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Markus Flepp
- Center for Infectious Diseases Zurich, Zurich, Switzerland
| | - Thanh Lecompte
- Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Estelle Moulin
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St. Gallen, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Cornelia Staehelin
- Division of Infectious Diseases and Hospital Epidemiology, University and Inselspital Berne, Berne, Switzerland
| | | | - Christoph A Fux
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
| | - Philip E Tarr
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland Bruderholz, University of Basel, Bruderholz, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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18
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Abstract
PURPOSE OF REVIEW The review describes the evidence for HIV preexposure prophylaxis (PrEP) with daily combined tenofovir disoproxil fumarate and emtricitabine for adolescents and young adults. Current recommendations are described, as are the unique medical, socioeconomic, and legal considerations regarding the use of PrEP for youth. RECENT FINDINGS PrEP with daily oral tenofovir disoproxil fumarate-emtricitabine has been shown to help prevent new HIV infection among adults at substantial risk. Evidence suggests a protective benefit of PrEP for youth at risk for HIV, although low adherence is emerging as a barrier to effective use. SUMMARY Effective use of antiretrovirals for PrEP represents a seminal development in HIV prevention efforts. Improving access and adherence to PrEP for youth has the potential to substantially reduce the incidence of HIV in this population.
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Affiliation(s)
- Emily B. Allen
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allegra Gordon
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas Krakower
- Fenway Health, The Fenway Institute, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katherine Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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19
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Seow CJ, Chen AW, Hoi WH, Dalan R. ENDOCRINE TRAINEES EXHIBIT SENSITIVE BUT CONSERVATIVE ATTITUDES TOWARDS THE MANAGEMENT OF ENDOCRINE CONDITIONS IN HIV PATIENTS IN SINGAPORE. Endocr Pract 2017; 23:1072-1076. [PMID: 28683238 DOI: 10.4158/ep171816.or] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE With advances in the treatment of human immunodeficiency virus (HIV) infections, the life expectancy of people with HIV (PWH) is fast approaching that of the general population. Endocrine and metabolic disorders occur more frequently in PWH than in the general population. This study assessed the knowledge, practice patterns, and confidence levels among endocrinology trainees in Singapore in managing endocrine disorders in PWH. METHODS An anonymous, 31-item survey was administered to 23 endocrinology trainees. Four domains were assessed: (1) previous exposure to endocrine disorders in PWH; (2) attitudes towards treating PWH, (3) case studies in endocrinology designed to assess for differences in treatment philosophy between a PWH and a noninfected counterpart, and (4) confidence in managing endocrine disorders in PWH. RESULTS The participation rate was 73.9%, with the majority of trainees (88.2%) having managed fewer than 5 PWH with endocrine disorders. A total of 94.1% of the trainees had little or no hesitation in treating PWH, but more than half (58.8%) felt inadequate in confidently managing them. A total of 82.4% deemed HIV endocrinology as an emerging field and were open to the idea of pursuing it as a subspecialty in the future. Re-assuringly, most trainees would not compromise medical treatment for a PWH if it were indicated. More than half were ambivalent about prescribing cross-hormonal therapy to transgender individuals. CONCLUSION Endocrinology trainees feel that while HIV endocrinology is an emerging field, they lack exposure, training, and confidence in the management of these patients. Although they would treat medical conditions well, they lacked knowledge in hormonal treatment of transgender individuals. ABBREVIATIONS HIV = human immunodeficiency virus PWH = people with HIV.
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