Changes in trabecular bone score and bone mineral density in Chinese HIV-Infected individuals after one year of antiretroviral therapy

• Published in: Journal of orthopaedic translation Vol. 29; pp. 72 - 77
• Main Authors: Guan, Wen-Min, Pan, Wei, Yu, Wei, Cao, Wei, Lin, Qiang, Zhang, Zai-Zhu, Song, Xiao-Jing, Li, Yan-Ling, Tian, Jun-Ping, Xu, Ying, Li, Tai-Sheng, Hsieh, Evelyn
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier (Singapore) Pte Ltd 01.07.2021; Chinese Speaking Orthopaedic Society; Elsevier
• Subjects: Antiretroviral therapy (ART); Bone mineral density (BMD); Human immunodeficiency virus (HIV); Original; Tenofovir disoproxil fumarate (TDF); Trabecular bone score (TBS); Trabecular bone score (TBS); Bone mineral density (BMD); Tenofovir disoproxil fumarate (TDF); Antiretroviral therapy (ART); Human immunodeficiency virus (HIV)
• ISSN: 2214-031X; 2214-0328
• DOI: 10.1016/j.jot.2021.04.002

Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) have been associated with reduced bone mineral density (BMD) in persons with HIV (PWH). BMD provides information only about bone mineral quantity. Trabecular bone score (TBS) is a noninvasive tool that estimates bone microarchitecture. The aim of this study is to measure BMD and TBS of Chinese PWH after one-year ART. We designed a retrospective study of adult Chinese PWH. Patients with a dual-energy X-ray absorptiometry (DXA) scan prior to ART initiation, and again 48 weeks later were included. Information regarding demographic and clinical history, HIV treatment history, BMD and TBS were collected. We analyzed differences in BMD and TBS over 48 weeks and associations between key risk factors and changes in BMD and TBS. Our study included 233 ​PWH (mean age ​= ​36.6 ​± ​11.1 years). Before ART initiation, 19.3% of PWH had normal BMD but abnormal TBS. Both BMD and TBS decreased after one-year ART. TDF and LPV/r-containing regimens were associated with greater declines in BMD at different site. Traditional risk factors such as old age, low BMI and female sex were associated with lower baseline TBS. Greater change in TBS over one year was associated with lower BMI and lower baseline CD4+ cell count, but unlike BMD measures, it was not correlated with treatment with TDF and LPV/r in our study population. We present the first longitudinal analysis of change in TBS over 48 weeks compared with BMD among Asian PWH receiving ART. Before ART initiation, approximately 20% of PWH with impaired bone microarchitecture would not have been identified if DXA were used alone to assess for bone damage. Both BMD and TBS decreased after one-year ART. Change in TBS was not associated with different antiretroviral agents. The trabecular microarchitecture measured indirectly by TBS may provide clinicians additional information about bone damage in PWH.