RESUMO
Accumulating evidence suggests that rates of low bone mass are greater in HIV-infected males than females. Of 11 biomarkers assessed by sex and HIV-status, HIV-infected males had increased levels of soluble CD14 which inversely correlated with bone mineral content and bone mineral density measures, suggesting macrophage activation as a possible mechanism of differential bone loss.
Assuntos
Terapia Antirretroviral de Alta Atividade , Densidade Óssea/efeitos dos fármacos , Doenças Ósseas Metabólicas/fisiopatologia , Infecções por HIV/fisiopatologia , Ativação de Macrófagos , Osteoporose/fisiopatologia , Coluna Vertebral/patologia , Absorciometria de Fóton , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/virologia , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Osteoporose/diagnóstico por imagem , Osteoporose/virologia , Porto Rico/epidemiologia , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To describe the alterations in the bone metabolism of HIV-seropositive patients and evaluate the effects of antiretroviral therapies. DESIGN: Cross-sectional analytical study. METHOD AND MATERIALS: A total of 142 subjects (113 male, 29 female), aged 20-45 years were divided into four groups: group A, 33 HIV-seropositive antiretroviral-naive patients; group B1, 36 HIV-seropositive patients on antiviral therapy for over 1 year, without protease inhibitors (PI); group B2, 42 HIV-seropositive patients on combined therapy containing PI for over 1 year; and group C, 15 healthy, HIV-seronegative subjects. Bone mineral density (BMD) were determined by dual energy X-ray absorptiometry in total body, lumbar spine and proximal femur; and evaluation of serum osteocalcin, d-pyridinoline, parathyroid hormone (THP), calcium and phosphate, and urine calcium. RESULTS: BMD was significantly lower in HIV-seropositive patients in comparison with healthy controls, in all sites studied. However, no statistical differences were observed among all groups of HIV-infected patients, independently of the antiretroviral therapy. There was a significantly higher occurrence of osteopenia and osteoporosis in HIV-infected patients in comparison with controls (P < 0.0001), with no differences among treatment-naive patients and either of the treatment groups. Bone formation and resorption markers were similar among all studied groups. There was a significant correlation in all bone sites between time of infection and BMD (P < 0.02). CONCLUSIONS: BMD was significantly lower in HIV-seropositive patients in comparison with controls in lumbar spine, proximal femur and total body, without significant differences among treatment-naive patients and either of the treatment groups. Only time with HIV infection and not specific therapy was associated with BMD decreases.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Doenças Ósseas Metabólicas/virologia , Infecções por HIV/complicações , Absorciometria de Fóton , Adulto , Antropometria , Fármacos Anti-HIV/uso terapêutico , Doenças Ósseas Metabólicas/induzido quimicamente , Estudos Transversais , Feminino , Colo do Fêmur/fisiopatologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoporose/induzido quimicamente , Osteoporose/virologia , Fatores de TempoRESUMO
Human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with changes in extracellular matrix of neural tissue. HTLV-I infection has multiple other systemic effects. Extracellular matrix is important for bone mineral deposition. We examined bone mineral density (BMD) in patients with HAM/TSP. BMD was assessed by ultrasonographic calcaneous densitometry in 24 patients (7 males, 17 females) with HAM/TPS, and 23 healthy HTLV-I-seronegative controls matched by age and sex. Patients with HAM/TPS had a mean BMD T-score of -3.07 +/- 0.64 in males and -2.93 +/- 0.69 in females. Control patients revealed a T-score of -0.77 +/- 1.31 in males and -1.17 +/- 1.08 females. The difference in T-score between HAM/TSP patients and control groups is significant (P < 0.001). Of HAM/TPS patients, 7 of 24 (29.2%) had osteopenia (T-score between -1 and -2.5) and 17 of 24 (70.8%) were diagnosed with osteoporosis (T < -2.5). Respective figures for control patients were 10 of 23 (43.5%) with a normal T-score, 11 of 23 (47.8%) with osteopenia, and 2 of 23 (8.7%) with osteoporosis. After adjustment for age and sex, odds ratio of osteoporosis for HAM/TSP patients was 31.52 (95% confidence interval, 5.07 to 195.88). No correlation was found in HAM/TSP patients between T-score and age, menstrual status, gait functionality, or years of evolution of HAM/TSP. HAM/TSP patients have a significantly diminished BMD of the calcaneous that appears not to be explained by paresis, age, years of disease, menstrual status; may be the result of systemic alterations due to HTLV-1 infection.