Longitudinal change in bone mineral density among Chinese individuals with HIV after initiation of antiretroviral therapy.
Longitudinal change in bone mineral density among Chinese individuals with HIV after initiation of antiretroviral therapy.
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DOI：
10.1007/s00198-020-05584-w
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发表时间：
2021-02
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艾滋病毒感染者（PLWH）患骨质疏松和骨折的风险增加。富马酸替诺福韦二氧吡酯（TDF）与较高的骨密度（BMD）丢失、骨质疏松和骨折发生率相关。在亚洲，很少有研究研究艾滋病对艾滋病患者的影响。我们回顾性分析了2007年3月至2016年5月中国北京一家大型三级医院HIV门诊的患者。在抗逆转录病毒治疗开始前和开始治疗后48周和/或96周进行双能x线吸收测定的患者被纳入本分析。共纳入136例患者（平均年龄36.0±10.6岁），90%以上为男性和汉族。我们观察到，与非TDF组相比，TDF组从基线到48周脊柱骨密度下降幅度更大（- 2.94%对- 0.74%），从基线到96周髋部骨密度下降幅度更大（- 4.37%对- 2.34%）。在HIV特异性参数方面，较长的HIV诊断时间和无法检测到的病毒载量与髋部BMD降低相关[相对危险度（RR） 0.97, 95%置信指数（CI） 0.95, 0.99)每增加1年，RR 0.96, 95%CI（0.94, 0.99）分别]和股骨颈[RR 0.97, 95%CI（0.95, 0.99）每增加1年，RR 0.97, 95%CI（0.95, 0.998）分别]超过96周。这是首个报道在中国开始基于tdf的抗逆转录病毒治疗后PLWH骨密度变化的研究。我们的发现为该地区PLWH的长期临床管理提供了重要的知识。这是首个报道中国HIV患者接受富马酸替诺福韦二氧吡酯（TDF）抗逆转录病毒治疗后BMD及相关危险因素变化的研究。与不含TDF方案的患者相比，接受TDF治疗的患者观察到更大的骨矿物质密度（BMD）损失。我们的研究结果为中国HIV患者长期临床管理的危险因素提供了重要的知识。
Persons living with HIV (PLWH) are at increased risk for osteoporosis and fracture. Tenofovir disoproxil fumarate (TDF) has been associated with higher rates of bone mineral density (BMD) loss, osteoporosis and fracture. Few studies have studied the impact among PLWH in Asia. We analyzed retrospectively patients from the outpatient HIV clinic of a large tertiary hospital in Beijing, China, from March 2007 to May 2016. Patients who had dual-energy x-ray absorptiometry testing prior to antiretroviral initiation, and at 48 and/or 96 weeks after initiation were included in this analysis. A total of 136 patients were included (mean age 36.0±10.6 years) and over 90% participants were male and Han Chinese ethnicity. We observed greater declines in BMD at the spine from baseline to week 48 (−2.94% vs. −0.74%) and at the hip from baseline to week 96 (−4.37% vs.−2.34%) in the TDF group compared with the non-TDF group. With regards to HIV-specific parameters, longer duration since HIV diagnosis and undetectable viral load over time were associated with lower BMD at the hip [Relative risk (RR) 0.97, 95% confidence index (CI) (0.95, 0.99) per 1 year increase and RR 0.96, 95%CI (0.94, 0.99), respectively] and femoral neck [RR 0.97, 95%CI (0.95, 0.99) per 1 year increase and RR 0.97, 95%CI (0.95, 0.998), respectively] over 96 weeks. This is the first study to report changes in BMD among PLWH after initiation of TDF-based antiretroviral therapy in China. Our findings provide important knowledge for the long-term clinical management of PLWH from this region. This is the first study to report changes in BMD and related risk factors among Chinese patients with HIV after initiation of tenofovir disoproxil fumarate (TDF)-containing antiretroviral therapy. Greater bone mineral density (BMD) loss was observed in patients treated with TDF, compared to those on non-TDF-containing regimens. Our findings provide important knowledge regarding the risk factors in the long-term clinical management of patients with HIV in China.