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Olali AZ, Shi Q, Hoover DR, Bucovsky M, Shane E, Yin MT, Ross RD. Bone and fat hormonal crosstalk with antiretroviral initiation. Bone 2022; 154:116208. [PMID: 34547525 PMCID: PMC8671338 DOI: 10.1016/j.bone.2021.116208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Bone mineral density (BMD) loss and fat gain is common in people living with HIV (PLWH), particularly after initiating combination antiretroviral therapy (cART). Given the close metabolic interaction between bone and fat, we tested the hypotheses that changes in bone-derived hormones are associated with fat accumulation and changes in fat-derived hormones are associated with BMD loss following cART initiation. METHODS HIV-seropositive subjects (n = 15) initiating fixed dose cART of tenofovir disoproxil fumarate/emtricitabine/efavirenz (TDF/FTC/EFV) underwent dual X-ray absorptiometry (DXA) assessment pre-cART and again 12-months post-cART initiation. DXA-derived measurements included BMD at the lumbar spine, femoral neck, total hip, and trochanter and the trunk and total fat. Serum undercarboxylated osteocalcin (ucOCN), sclerostin, lipocalin-2, leptin, and adiponectin were measured pre and post-cART. Spearman's rank-order correlations assessed the cross-sectional associations between hormones and bone and fat mass pre- and post-cART. Linear regression models adjusting for baseline bone or fat mass assessed the association between hormone change and BMD/fat changes following cART initiation. RESULTS ucOCN (p = 0.04) and lipocalin-2 (p = 0.03) increased post-cART while sclerostin, leptin, and adiponectin remained unchanged. BMD significantly decreased post-cART at all skeletal sites. Trunk and total fat increased post-cART but not significantly, while weight and BMI remained unchanged. In models adjusting for baseline BMD and fat mass, change in ucOCN was negatively associated with change in trunk (p = 0.008) and total fat (p = 0.01) and the change in leptin was positively associated with change in total hip (p = 0.03) and trochanteric BMD (p = 0.02). CONCLUSION The current study demonstrates bone-fat crosstalk in cART initiating PLWH.
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Affiliation(s)
- Arnold Z Olali
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Qiuhu Shi
- Department of Public Health, New York Medical College, Valhalla, NY, United States of America
| | - Donald R Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, United States of America
| | - Mariana Bucovsky
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Elizabeth Shane
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Michael T Yin
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Ryan D Ross
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America.
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Tasca KI, Fagundes Vidal VVM, Martinez Manfio V, Naime Barbosa A, de Souza LDR. Contributory role of ART in the development of non-AIDS comorbidities in asymptomatic PLWHA. J Appl Biomed 2021; 19:73-82. [PMID: 34907718 DOI: 10.32725/jab.2021.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the many benefits that follow antiretroviral therapy (ART) initiation, its chronic use contributes to the early aging of people living with HIV/AIDS (PLWHA). The aim of this cross-sectional study was to trace the prevalence of and investigate possible renal, bone and metabolic changes, as well as cardiovascular risk in 94 asymptomatic PLWHA, relating them to the duration of ART use. METHODS Four groups were evaluated according to ART use: G1 (n = 21), ART-naïve individuals; G2 (n = 17), <2 years; G3 (n = 40), 2-10 years; and G4 (n = 16) on ART for more than 10 years. RESULTS Our results showed a high prevalence of dyslipidemic individuals (64%), especially in those under ART. Lower creatine phosphokinase levels were observed in G1 as compared to the others (p < 0.05). Regarding the Framingham score, 12.1% of PLWHA showed moderate and high risk, and the highest proportion (38.5%) occurred in G4 (p = 0.003). A decrease in glomerular filtration rates occurred in 20% of patients, which was also more significant in G3 and G4 (p = 0.007). High prevalences of osteopenia and osteoporosis (53.2%) were found, especially in G1 and G4; however, G1 showed the lowest means for alkaline phosphatases (AP, p = 0.04 and BAP, p = 0.005) and osteocalcin (p = 0.005), in addition to higher vitamin-D concentrations (p = 0.04). CONCLUSIONS Our study showed the possible contributory role of ART in these changes, which leads us to reflect on the need for specific conducts and patient care, pointing out the importance of individualized care in an attempt to increase life expectancy.
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Affiliation(s)
- Karen Ingrid Tasca
- Sao Paulo State University - UNESP, Institute of Biosciences of Botucatu, Department of Microbiology and Immunology, Botucatu, Sao Paulo State, Brazil
| | - Vania V M Fagundes Vidal
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil
| | - Vanessa Martinez Manfio
- Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Alexandre Naime Barbosa
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Lenice do Rosario de Souza
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
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Wang Y, Huang X, Wu Y, Li A, Tian Y, Ren M, Li Z, Zhang T, Wu H, Wang W. Increased Risk of Vitamin D Deficiency Among HIV-Infected Individuals: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:722032. [PMID: 34490331 PMCID: PMC8418196 DOI: 10.3389/fnut.2021.722032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Human immunodeficiency virus (HIV) infection is a heavy burden worldwide. Observational studies have reported a high prevalence of vitamin D deficiency (VDD) among people living with HIV (PLWH). However, its deficiency is also a global health problem. Therefore, we conducted a meta-analysis and systemic review to compare differences between HIV-infected subjects and non-HIV-infected subjects. Methods: We searched PubMed, Web of Science, Embase, and Cochrane library. We extracted data, including demographic information, study type, vitamin D-related values, and HIV-related values, ultimately including 15 studies after removing duplicates and screening titles, abstracts, and full texts and finally performing a meta-analysis in terms of vitamin D level and vitamin D deficiency prevalence. Results: Regarding VDD prevalence, the HIV vs. the non-HIV group had an odds ratio of 1.502 (95% CI, 1.023–2.205; P = 0.038). In the subgroup analysis, the odds ratios were 1.647 (95% CI, 1.020–2.659; P = 0.041; I2 = 94.568) from 7 studies (age over 40), 2.120 (95% CI, 1.122–4.008; P = 0.021; I2 = 0.000) from 2 studies (BMI less than or equal to 25), 1.805 (95% CI, 1.373–2.372; P = 0.042; I2 = 74.576) from 7 studies (latitude <40), 2.120 (95% CI, 1.122–4.088; P = 0.021; I2 = 0.000) from 2 studies (only included male participants), and 2.296 (95% CI, 1.287–4.097; P = 0.005; I2 = 19.927) from 3 studies (only included ART-experienced participants). Thirteen studies were deemed to have moderate quality, while two had high quality. Conclusions: HIV infected subjects are prone to have VDD compared with general population. ART, older age, lower BMI, lower latitude and male sex may present risk factors for VDD in PLWH. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228096.
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Affiliation(s)
- Yingying Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaxin Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Aixin Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yakun Tian
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Meixin Ren
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Olali AZ, Sharma A, Shi Q, Hoover DR, Weber KM, French AL, McKay HS, Tien PC, Al-Harthi L, Yin MT, Ross RD. Change in Circulating Undercarboxylated Osteocalcin (ucOCN) Is Associated With Fat Accumulation in HIV-Seropositive Women. J Acquir Immune Defic Syndr 2021; 86:e139-e145. [PMID: 33399313 PMCID: PMC7933097 DOI: 10.1097/qai.0000000000002617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bone mineral density loss and fat accumulation are common in people living with HIV. The bone-derived hormone, undercarboxylated osteocalcin (ucOCN) regulates fat metabolism. We investigated the relationship between ucOCN change and body fat change among perimenopausal/postmenopausal HIV-seronegative and HIV-seropositive women on long-term antiretrovirals. METHODS Perimenopausal and postmenopausal women enrolled in the Women's Interagency HIV Study MSK substudy underwent trunk and total fat assessment by dual energy x-ray absorptiometry (DXA) at study enrollment (index visit) and again 2 years later. Circulating ucOCN and cOCN were also measured at the index and 2-year visits. The correlation between the 2-year change in ucOCN and cOCN and change in trunk and total fat was assessed as a function of HIV serostatus using linear regression modeling. Multivariate linear regression assessed the association between ucOCN and cOCN change and total and trunk fat change after adjusting for sociodemographic variables. Linear regression models restricted to HIV-seropositive women were performed to examine the contributions of HIV-specific factors (index CD4 count, viral load, and combined antiretroviral therapy use) on the associations. RESULTS Increased ucOCN over the 2-year follow-up was associated with less trunk and total fat accumulation in models adjusting for HIV serostatus and participants sociodemographics, whereas there was no association with cOCN and the fat parameters. None of the HIV-specific factors evaluated influenced the association between ucOCN and fat parameters. CONCLUSION The current study suggests that increases in ucOCN are associated with decreased fat accumulation in HIV-seronegative and HIV-seropositive postmenopausal women on long-term antiretroviral therapy.
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Affiliation(s)
- Arnold Z. Olali
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL
- Department of Microbial Pathogens and immunity, Rush University Medical Center, Chicago, IL
| | | | - Qiuhu Shi
- New York Medical College, Valhalla, NY
| | - Donald R. Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ
| | - Kathleen M. Weber
- Cook County Health/CORE Center and Hektoen Institute of Medicine, Chicago, IL
| | - Audrey L. French
- Department of Medicine, Stroger Hospital of Cook County/CORE Center, Rush University, Chicago, IL
| | - Heather S. McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA
| | - Lena Al-Harthi
- Department of Microbial Pathogens and immunity, Rush University Medical Center, Chicago, IL
| | | | - Ryan D. Ross
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL
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5
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Olawepo JO, Pharr JR, Cross CL, Kachen A, Olakunde BO, Sy FS. Changes in body mass index among people living with HIV who are new on highly active antiretroviral therapy: a systematic review and meta-analysis. AIDS Care 2020; 33:326-336. [PMID: 32460518 DOI: 10.1080/09540121.2020.1770181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In the era of highly active antiretroviral therapy (HAART), obesity is increasingly being reported among people living with HIV (PLHIV). In this study, we reviewed published literature on body mass index (BMI) changes among treatment-naïve adult PLHIV who started HAART and remained on treatment for at least six months. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, four databases were searched, and results of included studies were synthesized to describe the BMI trend among PLHIV on treatment. The search generated 4948 studies, of which 30 were included in the qualitative synthesis and 18 were eligible for the meta-analysis. All the studies showed an increase in group BMI. HAART was associated with increase in BMI (pooled effect size [ES] = 1.58 kg/m2; 95% CI: 1.36, 1.81). The heterogeneity among the 18 studies was high (I 2 = 85%; p < .01). Subgroup analyses showed pooled ES of 1.54 kg/m2 (95% CI: 1.21, 1.87) and 1.63 kg/m2 (95% CI: 1.34, 1.91) for studies with follow-up ≤1 year and >1 year, respectively. We conclude that the greatest gain in BMI is in the initial 6-12 months on treatment, with minor gains in the second and subsequent years of treatment.
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Affiliation(s)
- John O Olawepo
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Chad L Cross
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.,Department of Radiation Oncology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Axenya Kachen
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Francisco S Sy
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
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6
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Impact of Antiretroviral Drugs on Fracture Risk in HIV-Infected Individuals: A Case-Control Study Nested Within the French Hospital Database on HIV (FHDH-ANRS CO4). J Acquir Immune Defic Syndr 2019; 80:214-223. [PMID: 30422911 DOI: 10.1097/qai.0000000000001903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND HIV-infected patients have lower bone mineral density and a higher incidence of fractures than the general population of the same age and sex. To assess the impact of antiretroviral (ARV) drugs exposure on the risk of osteoporotic fractures, we conducted a nested case-control study. METHODS Cases were individuals enrolled while ARV-naive, with a first prospectively recorded fracture between 2000 and 2010. Controls were randomly selected after matching for sex, age (±3 years), period of HIV diagnosis (<1997/≥1997), and clinical center. The risk of fracture was analyzed with conditional logistic regression models, using different ways to model ARV exposure. All exposure variables and potential confounders were included in multivariable models. RESULTS Among 861 reviewed cases, 261 fractures were osteoporotic and 254 of cases were matched to at least one control (376 controls). The median year of fracture diagnosis was 2007 (interquartile range 2004-2009): 49% of patients had been exposed to tenofovir disoproxil fumarate (TDF) and 82% to protease inhibitors (PIs). After taking into account the transmission group, AIDS status, geographic origin, body mass index, current smoking status, alcohol consumption, exposure to systemic glucocorticoids, and the period of enrollment, there was no association between the risk of fracture and exposure to TDF [odds ratio for cumulative exposure: 1.04 (0.86-1.27), similar results for ever-exposed subjects], to nucleoside reverse transcriptase inhibitors, or to PIs [odds ratio for cumulative PI exposure: 1.02 (0.92-1.12)]. CONCLUSIONS We found no evidence of an excess risk of fracture after exposure to TDF or PIs. This has important implications for the debate concerning tenofovir alafenamide versus generic TDF.
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7
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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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8
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McGinty T, Mallon P. Protecting bone in long-term HIV positive patients receiving antiretrovirals. Expert Rev Anti Infect Ther 2017; 14:587-99. [PMID: 27189695 DOI: 10.1080/14787210.2016.1184570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION As the population of people living with HIV ages, the increase in non-AIDs morbidities is expected to increase in parallel. Maintaining bone health in those with HIV will be an important area of focus for the HIV clinician to prevent the morbidity and mortality associated with fragility fractures, the principal clinical sequela of low bone mineral density (BMD). Rates of fractures and prevalence of low bone mineral density, a risk factor for future fragility fractures, are already increased in the HIV positive population. AREAS COVERED This review examines the strategies to maintain bone health in those living with HIV from screening through to managing those with established low BMD or fracture, including the role for choice of or modification of antiretroviral therapy to maintain bone health. Expert commentary: The increasing complexity of managing bone health in the age of succesful antiretroviral therapy and an aging patient population as well as future perspectives which may help achieve the long term aim of minimising the impact of low BMD in those with HIV are discussed and explored.
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Affiliation(s)
- Tara McGinty
- a School of Medicine , University College Dublin , Dublin , Ireland
| | - Patrick Mallon
- a School of Medicine , University College Dublin , Dublin , Ireland
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Sudjaritruk T, Bunupuradah T, Aurpibul L, Kosalaraksa P, Kurniati N, Prasitsuebsai W, Sophonphan J, Sohn AH, Ananworanich J, Puthanakit T. Adverse bone health and abnormal bone turnover among perinatally HIV-infected Asian adolescents with virological suppression. HIV Med 2016; 18:235-244. [PMID: 27477214 DOI: 10.1111/hiv.12418] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence of low bone mass and assess its relationship with abnormal bone turnover among HIV-infected Asian adolescents. METHODS A multicentre, cross-sectional study was conducted at four paediatric HIV centres in Thailand and Indonesia. Perinatally HIV-infected adolescents aged 10-18 years receiving antiretroviral therapy (ART) with virological suppression (HIV RNA < 400 copies/mL) were enrolled. Study assessments included lumbar spine (L2-L4) dual-energy X-ray absorptiometry and measurement of bone turnover markers. Bone mineral density (BMD) and bone mineral apparent density (BMAD) Z-scores were calculated based on Thai normative age- and sex-matched references. Low bone mass was defined as BMD or BMAD Z-scores ≤ -2. RESULTS Of 396 participants, 57% were female. The median age was 15.0 [interquartile range (IQR) 13.3-16.9] years, and 73% were in Tanner stage 3-5. At enrolment, the median CD4 T-cell count was 734 (IQR 581-907) cells/μL, and 37% were on protease inhibitor (PI)-based regimens. The overall prevalence of lumbar spine BMD and BMAD Z-scores ≤ -2 were 16.4% and 8.3%, respectively. Z-scores were lower with older age, female sex, body mass index (BMI) <5th percentile, boosted PI exposure and CD4 T-cell percentage < 15% before ART initiation. Increased bone turnover markers were inversely associated with BMD and BMAD Z-scores. CONCLUSIONS Low bone mass was linked to older age, female sex, low BMI, boosted PI exposure, and poor immunological status before ART commencement in our cohort of perinatally HIV-infected Asian adolescents. Dysregulation of bone turnover was associated with bone demineralization. Screening for low bone mass should be implemented to identify individuals who might benefit from interventions to preserve bone health.
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Affiliation(s)
- T Sudjaritruk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - T Bunupuradah
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - L Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - P Kosalaraksa
- Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - N Kurniati
- Department of Child Health, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - W Prasitsuebsai
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - J Sophonphan
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - A H Sohn
- TREAT Asia/amfAR - The Foundation of AIDS Research, Bangkok, Thailand
| | - J Ananworanich
- The U.S. Military HIV Research Program, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - T Puthanakit
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Abstract
PURPOSE OF REVIEW HIV infection is an established risk factor for osteoporosis and bone fracture. Combination antiretroviral therapy (cART) increases bone resorption leading to an additional 2-6% bone mineral density (BMD) loss within the first 1-2 years of therapy. Although tenofovir disoproxil fumarate is often blamed for antiretroviral drug-associated bone loss, evidence abounds to suggest that other agents, including the protease inhibitors (PIs), have adverse bone effects. In the current review, we examine bone loss associated with protease inhibitor use, describing the relative magnitude of bone loss reported for individual protease inhibitors. We also review the potential mechanisms associated with protease inhibitor-induced bone loss. RECENT FINDINGS As a class, protease inhibitors contribute to a greater degree of bone loss than other anchor drugs. HIV disease reversal and the associated immune reconstitution following cART initiation play an important role in protease inhibitor-mediated bone loss in addition to plausible direct effects of protease inhibitors on bone cells. SUMMARY Protease inhibitors remain an important component of cART despite their adverse effects on bone. A better understanding of factors that drive HIV/cART-induced bone loss is needed to stem the rising rate of fracture in the HIV-infected population.
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Affiliation(s)
- Caitlin A. Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Grady Healthcare System, Atlanta, GA USA
| | - M. Neale Weitzmann
- Division of Endocrinology & Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Grady Healthcare System, Atlanta, GA USA
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Sudjaritruk T, Puthanakit T. Adverse bone health among children and adolescents growing up with HIV. J Virus Erad 2015; 1:159-67. [PMID: 27482407 PMCID: PMC4946734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adverse bone health is one of the important non-communicable conditions during the course of life-long HIV treatment. Adolescence is the critical period of bone mineral acquisition for attaining adult peak bone mass. With traditional and HIV-related risk factors, adolescents growing with HIV have a greater chance of having impaired bone mineral density (BMD). Prevalence of low BMD has been reported in 16-32% of HIV-infected adolescents from middle-income countries. The deep interaction between the immune and skeletal systems, called the immunoskeletal interface, is proposed as one of the underlying mechanisms of adverse bone health in HIV-infected individuals. Dual-energy X-ray absorptiometry (DXA) is a standard tool to assess BMD among HIV-infected adolescents. Non-invasive imaging techniques such as quantitative computed tomography (QCT) and quantitative magnetic resonance imaging (QMRI) provide more information on true volumetric density and bone microarchitecture. To date, there are no paediatric recommendations on the treatment and prevention of adverse bone health. Having a healthy lifestyle, routine weight-bearing exercises and adequate dietary intake are the standard approaches to optimise bone health. There are several ongoing randomised clinical trials using pharmacological treatment options, for example vitamin D, calcium and alendronate to improve bone health among this population.
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Affiliation(s)
- Tavitiya Sudjaritruk
- Department of Epidemiology,
Johns Hopkins Bloomberg School of Public Health,
Baltimore,
Maryland,
USA
- Department of Pediatrics, Faculty of Medicine,
Chiang Mai University,
Chiang Mai,
Thailand
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - Thanyawee Puthanakit
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- Department of Pediatrics, Faculty of Medicine,
Chulalongkorn University,
Bangkok,
Thailand
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Sudjaritruk T, Puthanakit T. Adverse bone health among children and adolescents growing up with HIV. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30506-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Maciejewska K, Drzazga Z, Kaszuba M. The changes in bone organic and inorganic matrix in newborn rats after maternal application of antiretroviral agents: Indinavir and zidovudine. Biofactors 2015; 41:198-208. [PMID: 26040542 DOI: 10.1002/biof.1215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/29/2015] [Indexed: 01/31/2023]
Abstract
This work presents results concerning influence of indinavir (protease inhibitor, PI(1)) and zidovudine (nucleoside and nucleotide inhibitor of reverse transcriptase, NRTI) administered to pregnant Wistar rat females on organic and mineral constituents of bones and teeth (mandibles, skulls, tibiae, femurs, and incisors) of their offspring at the age of: 7, 14, and 28 days studied by means of induced laser and X-ray fluorescence spectroscopy supported by digital radiography. Influence of indinavir administered to pregnant female rats on bone of their offspring revealed mainly in changes of mineral concentration: lowered Ca concentration and disturbances of trace elements. Zidovudine influenced organic matter more than inorganic matrix which was seen in enhancement of LIF fluorescence. However, there was also an unexpected increase of bone density for rats from zidovudine group, unlike indinavir group, observed. Our studies suggest that studied antiretroviral agents given to pregnant women, may have different destructive impact on bone state of their offspring in the first period of life. Maternal administration of zidovudine may delay development of organic matrix, while indinavir may have adverse effects on inorganic structure.
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Affiliation(s)
- Karina Maciejewska
- Department of Medical Physics, Institute of Physics, University of Silesia, Katowice, Poland
- Silesian Center for Education and Interdisciplinary Research, Chorzow, Poland
| | - Zofia Drzazga
- Department of Medical Physics, Institute of Physics, University of Silesia, Katowice, Poland
- Silesian Center for Education and Interdisciplinary Research, Chorzow, Poland
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Brown TT, Moser C, Currier JS, Ribaudo HJ, Rothenberg J, Kelesidis T, Yang O, Dubé MP, Murphy RL, Stein JH, McComsey GA. Changes in Bone Mineral Density After Initiation of Antiretroviral Treatment With Tenofovir Disoproxil Fumarate/Emtricitabine Plus Atazanavir/Ritonavir, Darunavir/Ritonavir, or Raltegravir. J Infect Dis 2015; 212:1241-9. [PMID: 25948863 DOI: 10.1093/infdis/jiv194] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/16/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Specific antiretroviral therapy (ART) medications and the severity of human immunodeficiency virus (HIV) disease before treatment contribute to bone mineral density (BMD) loss after ART initiation. METHODS We compared the percentage change in BMD over 96 weeks in 328 HIV-infected, treatment-naive individuals randomized equally to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) plus atazanavir/ritonavir (ATV/r), darunavir/ritonavir (DRV/r), or raltegravir (RAL). We also determined whether baseline levels of inflammation markers and immune activation were independently associated with BMD loss. RESULTS At week 96, the mean percentage changes from baseline in spine and hip BMDs were similar in the protease inhibitor (PI) arms (spine: -4.0% in the ATV/r group vs -3.6% in the DRV/r [P = .42]; hip: -3.9% in the ATV/r group vs -3.4% in the DRV/r group [P = .36]) but were greater in the combined PI arms than in the RAL arm (spine: -3.8% vs -1.8% [P < .001]; hip: -3.7% vs -2.4% [P = .005]). In multivariable analyses, higher baseline concentrations of high-sensitivity C-reactive protein, interleukin 6, and soluble CD14 were associated with greater total hip BMD loss, whereas markers of CD4(+) T-cell senescence and exhaustion (CD4(+)CD28(-)CD57(+)PD1(+)) and CD4(+) T-cell activation (CD4(+)CD38(+)HLA-DR(+)) were associated with lumbar spine BMD loss. CONCLUSIONS BMD losses 96 weeks after ART initiation were similar in magnitude among patients receiving PIs, ATV/r, or DRV/r but lowest among those receiving RAL. Inflammation and immune activation/senescence before ART initiation independently predicted subsequent BMD loss.
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Affiliation(s)
| | - Carlee Moser
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Judith S Currier
- David Geffen School of Medicine, University of California-Los Angeles
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | | | | | - Otto Yang
- David Geffen School of Medicine, University of California-Los Angeles
| | - Michael P Dubé
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Robert L Murphy
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James H Stein
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Grace A McComsey
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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