Background:  The relation between osteopenia (OPE), osteoporosis (OPO), and antiretroviral therapy, lipodystrophy (LD), hyperlipidemia, and other factors is not well established. This study was performed to evaluate the frequency of OPO/OPE in HIV+ males and to correlate these data with LD and markers of bone metabolism.

Methods:  This comparative study concerned 150 HIV+ male (25-55 years old) treated with the same classes of ARV for >18 months (50 with PI; 50 without PI (25 with 2 NRTI+1 NNRTI and 25 with 3 NRTI), or not treated (50). Judgment criteria were BMD measured by DEXA at 3 sites (femoral neck, trochanter, lumbar spine), habitus, diet, history of fractures, clinical signs of LD, glucidolipidic, hormonal and bone metabolism markers (cortisol, testosteron, sex hormon binding protein, D25 vitamin, leptin, osteocalin, alkaline phosphatases, PTH, IGF1, urinary crosslaps). DEXA and biological markers were compared to an age and sex-matched HIV negative control group.

Results:  Data are currently available for 119/150 patients (47 with PI, 47 without PI, 25 not treated).

Frequency of OPO+OPE was 7-13% in HIV negative control group and 55-62% in HIV+ patients according to the site of measurement; the mean Z-score ranged respectively between +0.66/+0.93 and –0.47/–1.13 (p<0.001). In HIV+ population OPO and OPE were more frequent on femoral neck in patients treated with PI. LD was present in 89% of patients treated with PI (predominant mixt forms), 74% of patients treated without PI (predominant atrophic forms) and 4% of untreated patients (p<0.001). In HIV+ population, osteocalcin was significantly decreased in not treated patients and patients treated without PI compared to patients treated with PI. Bone alkalin phosphatases were decreased in not treated patients compared to patients treated with PI. Crosslaps were increased in the 3 groups of patients

Conclusion: In HIV-infected population, OPO/OPE is frequent even in untreated patients. Cortical bone (femoral neck) seems more affected than trabecular bone in patients treated with PI. HIV infection could increase bone resorption and decrease bone formation, the later being partially restored with treatment.