Trabecular bone score and 3D-DXA in young, antiretroviral treatment-naïve patients in Madrid

Abstract

IntroductionLow bone mineral density (BMD) has been described as a non-AIDS-related event in human immunodeficiency virus (HIV)-patients, but it is poorly studied by dual-energy X-ray absorptiometry (DXA) and trabecular bone score (TBS) in young HIV-infected men who have received no previous antiretroviral treatment (ART).Material and methodsA retrospective study of 56 naïve-HIV-infected men under 50 years old with recently diagnosed HIV infection, between May 2012 and July 2017.ResultsThe mean age was 33.11 ±6.6 years, and they were 56.4% Caucasian and 43.6% Latin American. Regarding lifestyle and risk factors, 57% had previous exposure to tobacco and 31% reported drug use. Low BMD (Z-score < –2.0) was found in 21.4% of the patients, and partially degraded and degraded in 25% and 1.7%, respectively in TBS. We find significative prevalence of bone involvement among naïve HIV-infected men under 50 years old.ConclusionsFurther studies are necessary to evaluate if BMD assessment should be recommended in young HIV-infected patients.

Bone Deleterious Effects of Different NRTIs in Treatment-naïve HIV Patients After 12 and 48 Weeks of Treatment

“…Seto et al [ 46 ] also demonstrated that TAF is associated with a superior bone safety profile than that of TDF at more than 96 weeks of treatment, even in patients with risk factors associated with bone loss and higher initial FRAX scores. Our study demonstrates that these bone changes are observed even earlier, at the beginning of treatment (12 weeks), and in adult patients younger than 50 years, a population with a high rate of bone affectation even before treatment initiation [ 8 , 47 - 49 ]. Therefore, PLHIV of all ages may potentially benefit from avoiding therapies containing TDF, which has repeatedly been shown to cause BMD loss [ 16 , 26 , 48 , 50 - 52 ] .…”

“…Both the risk factors associated with HIV infection (malnutrition, low body weight, high tobacco and alcohol consumption, and low levels of vitamin D) and the disease itself induce bone remodeling through a complex interaction of T cells with osteoclasts and osteoblasts. In adults [ 3 , 5 - 8 ], a decrease in BMD has also been associated with prolonged antiretroviral treatment, principally tenofovir disoproxil fumarate (TDF), indicating that the initial loss of BMD after beginning cART may be due to effects of the medication [ 5 , 6 ]. However, several studies have shown bone damage in therapy-naïve HIV-infected patients [ 3 , 9 , 10 ], cases in which the main guidelines do not specifically recommend evaluating BMD [ 11 - 13 ].…”