629   Osteopenia in HIV-Infected Patients. Is It the Disease or Is It the Treatment?

H. Knobel*, A. Guelar, G. Valdecillo, I. Aymar, A. Díez, and X. Nogués.
Hosp. del Mar, Barcelona, Spain.

Background:Recent reports have outlined accelerated bone mineral loss in HIV-infected patients associated with protease-inhibitor (PI)-containing HAART. Changes in bone mineral metabolism were described in HIV-infected patients without HAART.

Methods:80 HIV-infected patients (58 male, 22 female, mean age (SD): 41 (8) y.) were enrolled in a cross-sectional study. 26 did not receive treatment (Group 1). 37 were on HAART that included PI (Group 2). 17 were on HAART without PI (Group 3). 100 healthy seronegative adults matched by age and sex (Group 4) were also included. Patients with known factors of osteopenia were excluded. Dual energy x-ray absorptiometry (DEXA) was performed to measure lumbar spine (L1—L4) and femoral neck bone mineral density (BMD) with T- and Z-scores. (T-score represents a SD in BMD within the mean of the population at age 30. Z-score represents a SD in BMD within the mean of the same age and sex group.) Osteopenia was defined as a lumbar T-score <-1 SD.

Results:Median Z-score in the different groups of patients: Lumbar: Group 1: -0.42 (SD 0.2); Group 2: -0.68 (SD 0.2); Group 3: -0.82 (SD 0.2); Group 4: -0.2 (SD 0.1). Femoral neck: Group 1: -1.02 (SD 0.2); Group 2: -1.27 (SD 0.2); Group 3: -0.86 (SD 0.2); Group 4: -0.2 (SD 0.1). No differences were found in HIV-infected patients irrespective of treatment. However, the HIV-infected patients have lower BMD compared to healthy adults in lumbar spine: - 0.43 (P: 0.001; CI 95 %: -0.67 to -0.18) and in femoral neck: -0.68 (P: 0.0001; CI 95 %: -0.91 to -0.44). BMD was not correlated with HIV categories, viral load, CD4 cell count, or duration of therapy and was correlated with weight (r: 0.3, P: 0.02). In men, osteopenia was present in 4/16 (25%) of naïves, in 12/30 (40%) of PI-treated patients, in 3/12 (33 %) of non-PI-treated patients and in 8/50 (16%) of healthy adults. Difference reaches statistical significance only between HIV-infected patients (34.5%) versus seronegative controls (16%) (P: 0.03; RR: 2.16 (1.04—4.46)).

Conclusions:Lower bone mineral density and a higher rate of osteopenia were found in HIV-infected patients compared with non-infected adults. Furthermore, cortical bone seems to be more affected. No clear association was found in relation to use of HAART or type of HAART.