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Womack JA, Murphy TE, Leo-Summers L, Bates J, Jarad S, Smith AC, Gill TM, Hsieh E, Rodriguez-Barradas MC, Tien PC, Yin MT, Brandt CA, Justice AC. Predictive Risk Model for Serious Falls Among Older Persons Living With HIV. J Acquir Immune Defic Syndr 2022; 91:168-174. [PMID: 36094483 PMCID: PMC9470988 DOI: 10.1097/qai.0000000000003030] [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: 01/27/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older (older than 50 years) persons living with HIV (PWH) are at elevated risk for falls. We explored how well our algorithm for predicting falls in a general population of middle-aged Veterans (age 45-65 years) worked among older PWH who use antiretroviral therapy (ART) and whether model fit improved with inclusion of specific ART classes. METHODS This analysis included 304,951 six-month person-intervals over a 15-year period (2001-2015) contributed by 26,373 older PWH from the Veterans Aging Cohort Study who were taking ART. Serious falls (those falls warranting a visit to a health care provider) were identified by external cause of injury codes and a machine-learning algorithm applied to radiology reports. Potential predictors included a fall within the past 12 months, demographics, body mass index, Veterans Aging Cohort Study Index 2.0 score, substance use, and measures of multimorbidity and polypharmacy. We assessed discrimination and calibration from application of the original coefficients (model derived from middle-aged Veterans) to older PWH and then reassessed by refitting the model using multivariable logistic regression with generalized estimating equations. We also explored whether model performance improved with indicators of ART classes. RESULTS With application of the original coefficients, discrimination was good (C-statistic 0.725; 95% CI: 0.719 to 0.730) but calibration was poor. After refitting the model, both discrimination (C-statistic 0.732; 95% CI: 0.727 to 0.734) and calibration were good. Including ART classes did not improve model performance. CONCLUSIONS After refitting their coefficients, the same variables predicted risk of serious falls among older PWH nearly and they had among middle-aged Veterans.
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Affiliation(s)
- Julie A Womack
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Nursing, West Haven, CT
| | | | | | - Jonathan Bates
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | | | | | - Evelyn Hsieh
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Maria C Rodriguez-Barradas
- Michael E DeBakey VA Medical Center, Infectious Diseases Section and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Phyllis C Tien
- University of California, San Francisco, CA
- Department of Veterans Affairs, San Francisco, CA
| | | | - Cynthia A Brandt
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
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Mazzitelli M, Branca Isabel P, Muramatsu T, Chirwa M, Mandalia S, Moyle G, Marta B, Milinkovic A. FRAX assessment in people ageing with HIV. HIV Med 2021; 23:103-108. [PMID: 34541758 DOI: 10.1111/hiv.13170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Current British HIV Association (BHIVA) guidelines recommend the use of FRAX for the routine assessment of bone fracture risk in people living with HIV over 50 years of age every 3 years. Bone mineral density measurement with dual-energy X-ray absorptiometry (DXA) scan is recommended for those with increased fracture risk (FRAX major > 10%). Our objectives were to estimate the prevalence of and risk factors for osteoporosis in a population of PLWH aged > 50 years and assess the utility of FRAX in predicting the presence of DXA-proven osteoporosis in this cohort. METHODS This was a cross-sectional study of a cohort of PLWH aged > 50 years attending the Chelsea and Westminster Hospital and who had a DXA scan between January 2009 and December 2018. FRAX scores were calculated using the Sheffield algorithm. Multiple regression models and Cohen's kappa values were used to assess risk factors for osteoporosis and agreement between FRAX and DXA scan results, respectively. RESULTS In all, 744 patients were included (92.9% male, mean age 56 ± 5 years). The prevalence rates of osteoporosis (at DXA scans) and osteopenia were 12.2% and 63.7%, respectively. FRAX major was > 10% in only two patients, while 90/91 (98.9%) patients with osteoporosis had a normal FRAX score. The presence of osteoporosis was significantly associated with low body mass index and estimated glomerular filtration rate (p < 0.05). CONCLUSION Our results indicate that FRAX scores did not predict the presence of osteoporosis in our population of PLWH over 50 years of age and therefore FRAX scores may not be the appropriate tool to define eligibility to perform DXA scans in PLWH.
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Affiliation(s)
- Maria Mazzitelli
- Research and Development Department, Chelsea and Westminster Hospital, London, UK.,Medical and Surgical Sciences Department, "Magna Graecia" University, Catanzaro, Italy
| | | | - Takashi Muramatsu
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mimie Chirwa
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Sundhiya Mandalia
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Graeme Moyle
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Boffito Marta
- Research and Development Department, Chelsea and Westminster Hospital, London, UK.,Division of Infectious Diseases, Imperial College, London, UK
| | - Ana Milinkovic
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
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3
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Vizcarra P, Gallego J, Vivancos MJ, Sifuentes WA, Llop M, Casado JL. Evaluation of the fracture risk assessment tool for determining bone disease and the impact of secondary causes of osteoporosis in people living with HIV. HIV Res Clin Pract 2020; 21:63-71. [PMID: 32698706 DOI: 10.1080/25787489.2020.1794438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among HIV-infected individuals, screening for bone disease is encouraged to assess reversible risk factors and plan therapeutic interventions. OBJECTIVE We assessed the usefulness of Fracture Risk Assessment (FRAX) tool to identify candidates for dual X-ray absorptiometry (DXA) scan, or individuals with bone loss progression. We further explored how secondary causes of osteoporosis are reflected on FRAX. METHODS Longitudinal study of 217 consecutive individuals (mean, 45.8 years, 24% females) included after DXA scan. FRAX was calculated without/with femoral neck bone mineral density (BMD), checking the box of "secondary osteoporosis" for all the individuals. RESULTS Low BMD was observed in 133/217 (61%) individuals, of whom 98.5% had not been selected as candidates for DXA by current FRAX thresholds. Specifically, 23% of individuals aged <50 had low BMD but none was candidate for DXA. Adding BMD data, FRAX results increased by 50-100%, with 2/217 individuals (1%) above the thresholds. Classical and HIV-related secondary causes of osteoporosis (observed in 98% overall) correlated with low BMD, modifying significantly FRAX results (HCV coinfection, +124%; longer time of HIV infection, +93%; longer time on antiretroviral therapy, +147%; tenofovir exposure +36%). Individuals with lower BMD and higher FRAX results at inclusion had less bone decline in a follow-up DXA after a median of 3.5 years. CONCLUSIONS Currently recommended FRAX thresholds are not useful to select candidates for DXA scan, which could delay its performance in a population with a high prevalence of secondary factors for low BMD. Classical and HIV-related factors alter BMD and fracture risk estimation.
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Affiliation(s)
- Pilar Vizcarra
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Juan Gallego
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María J Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Walter A Sifuentes
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Llop
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - José L Casado
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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4
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Pramukti I, Lindayani L, Chen YC, Yeh CY, Tai TW, Fetzer S, Ko NY. Bone fracture among people living with HIV: A systematic review and meta-regression of prevalence, incidence, and risk factors. PLoS One 2020; 15:e0233501. [PMID: 32497105 PMCID: PMC7271989 DOI: 10.1371/journal.pone.0233501] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction People living with HIV (PLWH) had a higher prevalence and incidence rate of bone fracture compared to general population. Although several studies have explored this phenomenon, the prevalence and incidence rate of fracture were varied. Objective The aim of the study is to determine and analyze the pooled prevalence, incidence rate of fracture and fracture risk factors among people living with HIV (PLWH). Methods PubMed, Cochrane Library, CINAHL with full Text, and Medline databases for studies published up to August 2019 were searched. Studies reporting the prevalence or incidence of fracture among PLWH were included. Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool. A meta-analysis with random-effects model was performed to determine pooled estimates of prevalence and incidence rates of fracture. A meta-regression was performed to determine the source of heterogeneity. Results The pooled estimated prevalence of fracture among PLWH was 6.6% (95% CI: 3.8–11.1) with pooled odds ratio of 1.9 (95%CI: 1.1–3.2) compared to the general population. The pooled estimates of fracture incidence were 11.3 per 1000 person-years (95% CI: 7.9–14.5) with incidence rate ratio (IRR) of 1.5 (95% CI: 1.3–1.8) compared to the general population. Risk factors for fracture incidence were older age (aHR 1.4, 95% CI: 1.3–1.6), smoking (aHR 1.3, 95% CI: 1.1–1.5), HIV/HCV co-infection (aHR 1.6, 95% CI: 1.3–1.9), and osteoporosis (aHR 3.3, 95% CI: 2.2–5.1). Conclusions Our finding highlights a higher risk of fracture among PLWH compared to the general population. Osteoporosis, smoking and HIV/HCV coinfection as the significant modifiable risk factors should be prioritized by the HIV health providers when care for PLWH.
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Affiliation(s)
- Iqbal Pramukti
- Department of Nursing, International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| | - Linlin Lindayani
- Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Yin Yeh
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Wei Tai
- Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Susan Fetzer
- Southern New Hampshire Medical Center, Nashua, New Hampshire, United States of America
| | - Nai-Ying Ko
- Department of Nursing, International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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Quigley A, MacKay-Lyons M. Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1701763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adria Quigley
- Department of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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6
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Assessment of trabecular bone score, an index of bone microarchitecture, in HIV positive and HIV negative persons within the HIV UPBEAT cohort. PLoS One 2019; 14:e0213440. [PMID: 30897099 PMCID: PMC6428393 DOI: 10.1371/journal.pone.0213440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/21/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Increased prevalence of low bone mineral density (BMD) and increased fracture incidence are observed in persons living with HIV (PLWH). The trabecular bone score (TBS) is a novel index of bone microarchitecture which improves fracture prediction independent of BMD. Methods The HIV UPBEAT study is a single centre, prospective cohort study that enrolled subjects with and without HIV from similar sociodemographic backgrounds for annual assessments of bone health. TBS was derived from lumbar spine (LS) dual-energy X-ray absorptiometry images. Univariate and multivariable linear regression was used to assess relationships between baseline TBS, BMD, sociodemographic and clinical factors. Results 463 subjects (201 HIV positive) were included; PLWH were younger and more likely male, of non-African ethnicity and current smokers. HIV was associated with a mean reduction of 0.037 [-0.060, -0.013] (p = 0.002) in TBS. Lower TBS was also associated with male gender, non-African ethnicity, current smoking status and lower LS BMD. HIV remained associated with lower TBS after adjustment for LS BMD, age, gender and ethnicity. However, adjustment for current smoking significantly attenuated the association between HIV and TBS, with further adjustment for higher bone turnover markers largely explaining any residual association. Among the sub-group of PLWH, exposure to protease inhibitors and lower nadir CD4+ T-cell counts were both predictors of lower TBS. Conclusions PLWH have lower TBS independent of LS BMD. However, this is largely explained by higher current smoking rates and higher bone turnover in those with HIV. Exposure to PI, but not tenofovir disproxil fumarate, also contributed to lower TBS in those with HIV.
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7
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Mirza FS, Luthra P, Chirch L. Endocrinological aspects of HIV infection. J Endocrinol Invest 2018; 41:881-899. [PMID: 29313284 DOI: 10.1007/s40618-017-0812-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/16/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients with human immunodeficiency virus (HIV) are living longer with effective antiretroviral therapies and are enjoying near normal life span. Therefore, they are encountering endocrine issues faced by the general population along with those specific to HIV infection. The purpose of this article is to review the common endocrine aspects of HIV infection, and the early detection and management strategies for these complications. METHODS Recent literature on HIV and endocrine disease was reviewed. RESULTS HIV can influence endocrine glands at several levels. Endocrine glandular function may be altered by the direct effect of HIV viral proteins, through generation of systemic and local cytokines and the inflammatory response and via glandular involvement with opportunistic infections and HIV-related malignancies. Endocrine disorders seen in people with HIV include metabolic issues related to obesity such as diabetes, hyperlipidemia, lipohypertrophy, lipoatrophy and lipodystrophy and contribute significantly to quality of life, morbidity and mortality. In addition, hypogonadism, osteopenia and osteoporosis are also more prevalent in the patients with HIV. Although disorders of hypothalamic-pituitary-adrenal axis resulting in adrenal insufficiency can be life threatening, these along with thyroid dysfunction are being seen less commonly in the antiretroviral therapy (ART) era. ARTs have greatly improved life expectancy in people living with HIV but can also have adverse endocrine effects. CONCLUSIONS Clinicians need to have a high index of suspicion for endocrine abnormalities in people with HIV as they can be potentially life threatening if untreated. Endocrine evaluation should be pursued as in the general population, with focus on prevention, early detection and treatment to improve quality of life and longevity.
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Affiliation(s)
- F S Mirza
- Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-5456, USA.
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA.
| | - P Luthra
- Division of Endocrinology and Metabolism, Department of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-5456, USA
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
| | - L Chirch
- Division of Infectious Diseases, UConn Health, Farmington, CT, 06030, USA
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
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8
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Cammarota S, Citarella A, Manzoli L, Flacco ME, Parruti G. Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:389-398. [PMID: 30087571 PMCID: PMC6061204 DOI: 10.2147/ceor.s162625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Due to the success of antiretroviral therapy, human immunodeficiency virus (HIV) infection has been transformed into a lifelong condition. In Italy, little is known about the impact of comorbidities (CMs) on the risk of hospitalization and related costs for people who live with HIV (PWLHIV). The objective of the study was to quantify the risk of hospitalization and costs associated with CMs in an Italian cohort of PWLHIV. Methods The study population included subjects aged ≥18 years with HIV infection, identified in the Abruzzo’s hospital discharge database among files stored from 2004 until 2013 and then followed up until December 2015. Patients’ CMs (Charlson Comorbidity Index [CCI)] were extracted from International Classification of Diseases, Ninth Revision, Clinical Modification codes in the hospital discharge abstracts. Poisson regression was used to compare the incidence rate of hospital admissions in patients with and without each CM class. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were adjusted for age, sex and the other CMs. A generalized linear model under gamma distribution was used to estimate adjusted mean hospital costs. Costs were derived from official Italian Diagnosis-related group (DRG) based reimbursements. Results Among 1,026 HIV patients identified (mean age 47 years), 30% had at least one CM and 14.5% underwent hospital admission during the follow-up period. The risk of acute hospitalization significantly increased among patients with hepatitis C virus (HCV) coinfection (adjusted IRR 1.98; 95% CI: 1.59–2.47), renal (adjusted IRR 2.27; 95% CI: 1.45–3.56), liver (adjusted IRR 2.21; 1.57–3.13) and chronic pulmonary CMs (adjusted IRR 2.31; 1.63–3.32). Adjusted mean hospital costs were €2,494 in patients without CMs and €4,422 and €9,734 in those with CCI=1 or CCI ≥2, respectively. Conclusion The presence of renal, liver and chronic pulmonary CMs, as well as HCV coinfection doubled the risk of hospitalization in the PWLHIV cohort. A CCI ≥2 is associated with a fourfold increase in hospitalization costs. Our study provides new evidence that CMs in PWLHIV increase the risk of hospitalization and local health service facilities.
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Affiliation(s)
- Simona Cammarota
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Anna Citarella
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Lamberto Manzoli
- Department of Medicine Sciences, University of Ferrara, Ferrara, Italy.,Regional Healthcare Agency of Abruzzo, Pescara, Italy
| | | | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy,
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9
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Perazzo J, Webel AR, Alam SK, Sattar A, McComsey G. Relationships Between Physical Activity and Bone Density in People Living with HIV: Results from the SATURN-HIV Study. J Assoc Nurses AIDS Care 2018; 29:528-537. [PMID: 29735237 PMCID: PMC5999576 DOI: 10.1016/j.jana.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 12/31/2022]
Abstract
We conducted a cross-sectional secondary analysis of baseline data from the SATURN-HIV study (N = 147; 78% male, 68% Black, median body mass index [BMI] 26.72 kg/m2, 13% with osteopenia, HIV-1 RNA < 1,000 copies/mL, stable antiretroviral therapy [ART]) to explore the relationship between physical activity (PA) and bone mineral density (BMD). We measured self-reported minutes of PA and BMD in the overall sample and subgroups based on national recommendations (≥150 minutes/week). Forty-one (28%) participants met recommended PA levels. Higher intensity PA was associated with higher BMD at the total hip (r = 0.27, p = .09; n = 41; 28%) and lumbar spine (r = 0.32, p < .05), and predicted higher BMD at the hip (p < .01; controlling for age, BMI, ART). Lumbar spine BMD did not retain significance in the regression model. Moderate-to-high intensity PA could prevent or mitigate excessive bone loss in people living with HIV.
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Affiliation(s)
- Joseph Perazzo
- University of Cincinnati, Cincinnati, Ohio, USA and former postdoctoral fellow at Case Western Reserve University, Cleveland Ohio, USA
| | - Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Case Western Reserve University, Cleveland, Ohio, USA
| | - S.M. Khurshid Alam
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Abdus Sattar
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Grace McComsey
- Case Rainbow Babies & Children's Hospital, Case Western Reserve University/Case Medical Center, Cleveland, Ohio, USA
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10
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Premaor MO, Compston JE. The Hidden Burden of Fractures in People Living With HIV. JBMR Plus 2018; 2:247-256. [PMID: 30283906 PMCID: PMC6139727 DOI: 10.1002/jbm4.10055] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023] Open
Abstract
The survival of people living with human immunodeficiency virus (HIV) has increased markedly since the advent of antiretroviral therapy (ART). However, other morbidities have emerged, including osteoporosis. The estimated incidence of fractures at any site in people living with HIV ranges from 0.1 per 1000 person‐years to 8.4 per 1000 person‐years: at least twice that of people without HIV. This increased risk seems to be related to HIV itself and its treatment. Risk factors for bone disease in HIV‐positive (HIV+) subjects include both classical risk factors for osteoporosis and fracture and factors linked to HIV itself, such as inflammation, reconstitution syndrome, low CD4, ART, and co‐infection with hepatitis B and C viruses. The risk of fractures in these individuals can be at least partially assessed by measurement of BMD and the Fracture Risk Assessment Tool (FRAX™). Only alendronate and zoledronic acid have been studied in HIV+ individuals; both show beneficial effects on BMD, although data on fracture reduction are not available. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Melissa O Premaor
- Department of Clinical Medicine Health Sciences Center Federal University of Santa Maria Santa Maria Brazil
| | - Juliet E Compston
- Department of Medicine Cambridge Biomedical Campus Cambridge United Kingdom
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11
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Ilha TASH, Comim FV, Copes RM, Compston JE, Premaor MO. HIV and Vertebral Fractures: a Systematic Review and Metanalysis. Sci Rep 2018; 8:7838. [PMID: 29777162 PMCID: PMC5959850 DOI: 10.1038/s41598-018-26312-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/09/2018] [Indexed: 12/15/2022] Open
Abstract
The survival of HIV-infected patients has increased with the advent of antiretroviral therapy with the emergence of new comorbidities. Vertebral fracture is a manifestation of reduced bone strength and osteoporosis. This study aims to assess the frequency of spine fractures in HIV-positive men and women aged over 18 years. We performed a systematic review of randomized controlled trials, cohort studies, cross-sectional studies, and case-control studies. Studies that evaluated morphometric and/or clinical vertebral fracture were included. In total 488 studies were found, of which 53 had their full texts evaluated. A total of 85,411 HIV positive individuals were identified in 26 studies. The meta-analysis of the prevalence of vertebral fractures included 12 studies with 10,593 subjects. The prevalence was 11.1% [95% confidence interval (95% CI) 4.5%, 25.0%, I2 98.2% p < 0.00001]. When we evaluated independently studies of clinical vertebral fracture and morphometric vertebral fracture, the prevalence was 3.9% (95% CI 0.9, 15.8, I2 96.4% p < 0.00001) and 20.2% (95% CI 15.7%, 25.6%, I2 69.9% p = 0.003) respectively. HIV-infected individuals had an odds ratio of vertebral fractures of 2.3 (95% CI 1.37, 3.85, I2 98.2% p < 0.00001) when compared with HIV-uninfected patients (n = 9 studies). In conclusion, HIV-positive subjects had a higher risk of vertebral fractures when compared with HIV-negative subjects.
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Affiliation(s)
- Thales A S H Ilha
- Pós-graduação em Farmacologia, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Fabio V Comim
- Pós-graduação em Farmacologia, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Clinical Medicine, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Rafaela M Copes
- Pós-graduação em Farmacologia, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Clinical Medicine, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Melissa O Premaor
- Pós-graduação em Farmacologia, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil. .,Department of Clinical Medicine, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil.
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12
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Di Biagio A, Lorenzini P, Gustinetti G, Rusconi S, De Luca A, Lapadula G, Lo Caputo S, Cicalini S, Castelli F, Marchetti G, Antinori A, Monforte AD. Durability of Second Antiretroviral Regimens in the Italian Cohort Naive Antiretrovirals Foundation Study and Factors Associated with Discontinuation. AIDS Patient Care STDS 2017; 31:487-494. [PMID: 29211512 DOI: 10.1089/apc.2017.0140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The study was designed to investigate the median duration of second antiretroviral regimens and factors associated with early discontinuation in HIV patients who switched with an undetectable viral load. We conducted a retrospective analysis of the Italian Cohort Naive Antiretrovirals Foundation Study (ICONA), which collects data throughout the country. Patients who started first antiretroviral therapy (ART) after January 1, 2008 in any center involved in this cohort and then switched to a second regimen were included in the study. Second ART failure was described as two HIV-RNA >200 copies/mL or the discontinuation of any drug. Statistical analysis was performed utilizing Kaplan-Meier curves and Cox regression model. The study population included 835 patients and the median duration of first ART regimens was 16 months with HIV-RNA undetectable for 13 months. The main causes of switch to second ART regimens were toxicity (42.5%) and simplification (37.5%). The switch mostly involved the third drug (63.5%) and almost one third of the population received a single-tablet regimen (STR) as second treatment (30.6%). The median duration of second ART regimens was 9.2 months and the probabilities of treatment discontinuation at 12, 24, and 36 months were 21%, 35%, and 48.2%, respectively. STR formulations had a protective effect against second ART discontinuation. Almost half of our population needed a third regimen within 3 years, but STR could improve second ART durability.
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Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico S. Martino, Genoa, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases, IRCCS L. Spallanzani, Rome, Italy
| | - Giulia Gustinetti
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico S. Martino, Genoa, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Sacco Hospital, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, University of Milan, Milan, Italy
| | - Andrea De Luca
- Malattie Infettive Universitarie, ed Epatologia, Dipartimento di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | - Stefania Cicalini
- National Institute for Infectious Diseases, IRCCS L. Spallanzani, Rome, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy
| | - Giulia Marchetti
- Division of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, IRCCS L. Spallanzani, Rome, Italy
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Abstract
PURPOSE OF REVIEW Skeletal fractures are more common in HIV, and impact the medical, functional and economic status of frequently vulnerable patients. Identifying asymptomatic patients with low bone mineral density (BMD)/osteoporosis requiring intervention can be expected to reduce fracture risk and complications. Clinical tools are available to determine fracture risk in the general population and are being evaluated in HIV patients. The FRAX calculator, incorporating demographics and risk factors for osteoporosis, with or without BMD results, has been investigated most often in HIV patients. RECENT FINDINGS The few published studies that have calculated the 10-year FRAX risk for both major osteoporosis and hip fractures without BMD generally show limited precision in predicting the presence of osteoporosis severe enough to initiate treatment. It remains uncertain whether using HIV as a secondary risk factor and adding dual X-ray absorptiometry (DXA)-BMD information improves case-finding compared with using DXA results only. Not incorporating risks relevant to aging HIV patients such as antiretroviral exposure, hepatitis C virus coinfection and history of falls is other potential limitation. SUMMARY Accurate screening tools using clinical risk factors alone to determine fracture risk in HIV are not yet available. Further research and validation studies are necessary.
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Matovu FK, Wattanachanya L, Beksinska M, Pettifor JM, Ruxrungtham K. Bone health and HIV in resource-limited settings: a scoping review. Curr Opin HIV AIDS 2016; 11:306-25. [PMID: 27023284 PMCID: PMC5578733 DOI: 10.1097/coh.0000000000000274] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Sub-Saharan Africa and other resource-limited settings (RLS) bear the greatest burden of the HIV epidemic globally. Advantageously, the expanding access to antiretroviral therapy (ART) has resulted in increased survival of HIV individuals in the last 2 decades. Data from resource rich settings provide evidence of increased risk of comorbid conditions such as osteoporosis and fragility fractures among HIV-infected populations. We provide the first review of published and presented data synthesizing the current state of knowledge on bone health and HIV in RLS. RECENT FINDINGS With few exceptions, we found a high prevalence of low bone mineral density (BMD) and hypovitaminosis D among HIV-infected populations in both RLS and resource rich settings. Although most recognized risk factors for bone loss are similar across settings, in certain RLS there is a high prevalence of both non-HIV-specific risk factors and HIV-specific risk factors, including advanced HIV disease and widespread use of ART, including tenofovir disoproxil fumarate, a non-BMD sparing ART. Of great concern, we neither found published data on the effect of tenofovir disoproxil fumarate initiation on BMD, nor any data on incidence and prevalence of fractures among HIV-infected populations in RLS. SUMMARY To date, the prevalence and squeal of metabolic bone diseases in RLS are poorly described. This review highlights important gaps in our knowledge about HIV-associated bone health comorbidities in RLS. This creates an urgent need for targeted research that can inform HIV care and management guidelines in RLS.
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Affiliation(s)
- Flavia Kiweewa Matovu
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Flavia Kiweewa Matovu and Lalita Wattanachanya contributed equally to the writing of this article
| | - Lalita Wattanachanya
- Division of Endocrinology and Metabolism, Department of Medicine, and Hormonal and Metabolic Disorders Research Unit, Faculty of Medicine, Chulalongkorn University
- Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Flavia Kiweewa Matovu and Lalita Wattanachanya contributed equally to the writing of this article
| | - Mags Beksinska
- Maternal, Adolescent and Child Health (MatCH) Research, University of the Witwatersrand, Faculty of Health Sciences, Department of Obstetrics and Gynaecology
| | - John M. Pettifor
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kiat Ruxrungtham
- Department of Medicine, Faculty of Medicine, Chulalongkorn University
- HIV-NAT, Thai Red Cross AIDS Research Center, Thai Red Cross Society, Bangkok, Thailand
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Abstract
PURPOSE OF REVIEW Because of antiretroviral therapy (ART), people are living with HIV infection longer than ever before. As this patient group ages, it is expected that medical comorbidities such as osteoporosis and fragility fractures will increase. The purpose of this review is to address the epidemiology and what is known regarding the pathogenesis of bone loss in people living with HIV infection with a focus on recently published literature. RECENT FINDINGS HIV-infected individuals are at increased risk for low bone mineral density and bone fractures. The cause of bone loss in HIV is multifactorial including traditional risk factors some of which disproportionately affect HIV-infected individuals and alterations in bone metabolism due to ART, HIV viral proteins and chronic inflammation. Lifestyle modification, changing ART, calcium and vitamin D supplementation and pharmacologic treatment for osteoporosis may all be employed to abrogate bone loss in this patient group. SUMMARY Clinicians should be aware of the contributors to bone loss in people living with HIV in order to recognize high-risk individuals and to take appropriate steps to address modifiable risk factors to prevent future fracture.
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Affiliation(s)
- Corrilynn O Hileman
- Metrohealth Medical Center, Cleveland, Ohio, USA
- Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | | | - Grace A McComsey
- Case Western Reserve School of Medicine, Cleveland, Ohio, USA
- University Hospitals Case Medical Center, Cleveland, Ohio, USA
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