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Immunologic Biomarkers, Morbidity, and Mortality in Treated HIV Infection

Rosuvastatin slows progression of subclinical atherosclerosis in patients with treated HIV infection

Antiretroviral therapy for the prevention of HIV-1 transmission

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Association of immune-activation and senescence markers with non-AIDS-defining comorbidities in HIV-suppressed patients

Effects of randomized rosuvastatin compared with placebo on bone and body composition among HIV-infected adults

Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy

Cancer Risk and Use of Protease Inhibitor or Nonnucleoside Reverse Transcriptase Inhibitor–Based Combination Antiretroviral Therapy The D:A:D Study

Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study

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The effect of cumulating exposure to abacavir on the risk of cardiovascular disease events in patients from the Swiss HIV Cohort Study

Course and Clinical Significance of CD8+ T-Cell Counts in a Large Cohort of HIV-Infected Individuals

Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

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Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals

Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study

CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: an observational cohort study

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Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Low Bone Mineral Density in Patients With Well-Suppressed HIV Infection: Association With Body Weight, Smoking, and Prior Advanced HIV Disease

Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

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Low Bone Mineral Density in Patients With Well-Suppressed HIV Infection: Association With Body Weight, Smoking, and Prior Advanced HIV Disease
Published by Pedro CAHN

Updated: 1 March, 2015

Kooij KW, Wit FW, Bisschop PH, Schouten J, Stolte IG, Prins M, van der Valk M, Prins JM, van Eck-Smit BL, Lips P, Reiss P; AGEhIV Cohort Study group. J Infect Dis. 2015 Feb 15;211(4):539-48.

The AGEhIV cohort study is an ongoing, prospective, cohort study in Amsterdam, with 598 HIV-1 infected individuals and a control group of 550 HIV-uninfected individuals, from the same geographic region and with similar socio-demographic and behavioral risks factors. All participants were included between 2010 and 2012, with an age ≥ 45 years. In this study, both mineral density(BMD) was evaluated by DXA scanning performed at enrolment in the cohort. Multivariable linear regression models assessed whether HIV positive status was independently associated with BMD in the lumbar spine, total hip, and femoral neck as continuous dependence variable. All models were adjusted for age, sex, menopausal status, body weight, race (black or not black), and smoking status. Final models were also adjusted for the following co-variates: physical activity, intake of dairy/fish, prescription drug and substance use, family's history of hip fracture, and HBV and HCV infection or co-infection. Finally, levels of hsCRP, D-dimer , sCD163, sCD14 and 25-hydroxy vitamin D2+D3 were also explored as potential mediators in the association between HIV and BMD. For the HIV population, multi-variable models explored as co-variates duration of HIV-infection, CDC stage, historic body weight, current and nadir CD4 cells counts, HIV-1 plasma viral load, current and prior cART use and its duration. DXA of lumbar spine, total hip, and femoral neck was performed in 581 HIV-positive (94.7% receiving cART) and 520 HIV-negative participants. The population largely consisted of men (86.7%); 79% of male were MSM. Osteoporosis ( T score ≤ -2.5 SD) or osteopenia (T score between -1 and -2.5 SD) in each of the 3 locations were significantly higher in HIV-infected individuals: prevalence of osteoporosis in ≥ 1 site 14.3% vs 6.7%; p< 0.001; total hip osteopenia: 29% vs 16%, p< 0.001. After adjustment for body weight and smoking, being HIV-positive was no longer independently associated with BMD. Low body weight was more strongly negatively associated with BMD in HIV-positive persons with a history of class B or C events. HIV co-variate such as duration of HIV infection, current or nadir CD4 cell count, CD4/CD8 cell count ratio, markers of HIV replication, pre-treatment with mono or dual NRTI were not associated with BMD. The lowest recorded historic body weight was associated significantly with BMD in the lumbar spine and femoral neck. A significant positive association was observed between current use of nevirapine and BMD in all 3 locations, and a significant negative association between the duration of exposure to high dose (≥ 400 mg/day) ritonavir and BMD in the femoral neck and total hip. Other types of ART, including current or prior TDF use or its duration, were not associated with BMD.

Conclusion: the observed lower BMD in treated HIV positive individuals was largely explained by both lower body weight and more smoking. Having experienced symptomatic HIV disease, often associated with weight loss, was another risk factor.