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Bone Mineral Density in HIV/AIDS: A Case Control Study with Review of Literature

Atul Kakar

Background: With the advent of Anti-Retroviral Therapy (ART) and prophylactic antibiotic therapy life expectancy of HIV/AIDS patients has increased. The focus has now shifted from communicable to non-communicable diseases. The awareness of bone health in HIV is lacking among the physicians who are treating People Living with HIV/AIDS (Human Imunnodeficiency Virus/Acquired Immuno Deficiency Syndrome) (PLHA). Aim of this study is to find the prevalence and risk factors of low bone mineral density in PLHA and also the significance of vitamin D on bone health.

Methods: The study was a case control study conducted in a tertiary care center in heart of Delhi, India, over a period of 15 months (March 2013 to June 2014). Consenting patients with HIV, aged above 18 years, form the subjects of the study. Healthy individuals were taken as controls. Both the groups were evaluated for bone diseases, traditional risk factors and HIV related risk factors.

Results: Among cases, 88.3% had low bone mineral density as compared to 31.7% in the control population. In the risk factors, there was no statistical difference found between the two groups in terms of physical activity (p=0.098), sun exposure (p=0.196), calcium intake (p=0.273), history of alcohol consumption (p=0.853), history of smoking (p=0.852). BMD among non-smokers (p=0.00) in both the groups and history of fractures (p=0.013) were statistically significant between both the groups. Duration of HIV infection (p=0.553), median absolute CD4 count (p=0.128) and the median viral load (p=0.743) were not significantly related to bone density. Similarly tenofovir based ART regimen was also not associated significantly with bone mineral density in our study (p=0.417). Association of vitamin D deficiency with low BMD in between both case and control groups was statistically significant (p=0.00). The mean of FRAX score in study group was 2.387( ± 3.5805) % and in the control was 0.902( ± 2.3709) %. The difference was statistically significant (p=0.00).

Conclusion

HIV infected individuals have 16 times more risk of developing low BMD than uninfected individuals. Traditional risk factors and HIV related factors do not have a correlation with this low BMD. Vitamin D deficiency is a significant risk factor for low BMD in both HIV infected and uninfected population.