Session 19aOral Abstract Presentations Maternal-Fetal/Pediatrics/Women's Health Session Day and Time: Wednesday 10 am - 12 noon Presentation Time: 11:45 Room: 302-306
103 HIV Infection and Protease Inhibitor Use are Not Associated with Reduced Bone Mineral Density in Older HIV-infected Women J. H. Arnsten*1,2, R. Freeman1,2, N. Santoro1,2, E. E. Schoenbaum1,2 1Montefiore Med Ctr, Bronx, NY and 2Albert Einstein Coll of Med, Bronx, NY
Background: Osteopenia is an adverse event in HIV-infected patients (pts) and a sequelae of normal aging in women. To date, no studies have described the prevalence of reduced bone mineral density (BMD) in older, peri- and post-menopausal HIV-infected women.
Methods: Using dual-energy X-ray absorptiometry, we analyzed BMD of the lumbar spine, hip, and total body in 284 older (age > 35) women, including 140 HIV-infected and 144 HIV-uninfected women. We also analyzed the impact of protease-inhibitor (PI) use on BMD.
Results: The median age was 45 yrs (range 35-65). Twenty-four percent (24%; n = 67) were post-menopausal (no menses in the past 1 yr); all others were defined as peri-menopasual. Forty-two percent (42%) were African American, 42% Hispanic, and 19% Caucasian; mean body weight was 78.1 kg (range 36-145) and mean BMI was 29.7 (range 14.7-54); 94% of subjects had ever smoked cigarettes and 73% were current smokers; and 40% (n = 115) were physically inactive. Among HIV-infected women, 89% had taken antiretrovirals (ART) and 67% (n = 94) had taken PIs. Median duration of ART use was 36 months (mos) (range 1-120), and median duration of PI use was 24 mos (range 1-84). Median CD4 count was 459 cells/mm3. The prevalence of osteopenia (spine, hip, or total body T-score < -1.0) among all women was 31% (n = 71), and the prevalence of osteoporosis (T-score < -2.5) was 5% (n = 11). In univariate analysis, factors associated with osteopenia were BMI (28.5 vs 31.0, p = 0.02) and age (45.2 vs 43.9, p < 0.01); these factors remained predictive in a multi-variate model controlling for race, physical inactivity, smoking, and HIV status. Osteoporosis was more prevalent in post-menopausal (OR = 6.8, p < 0.001), physically inactive (OR = 3.9, p = 0.04), and white (OR = 3.5, p = 0.04) women. HIV infection was not associated with either osteopenia or osteoporosis. In contrast with previous studies, we found that women who had used PIs for more than 1 yr were significantly less likely to have osteopenia than women who had used PIs for less than 1 yr or not at all (OR = 0.3, p < 0.01). The protective effect of PI use on the development of osteopenia persisted after controlling for age, BMI, race, physical inactivity, and CD4 count in a multi-variate model (adjusted OR = 0.2, p = 0.02).
Conclusions: HIV infection is not associated with osteopenia in peri- and post-menopausal women. PI use among older HIV-infected women may protect against bone mineral loss by modifying cytokine-mediated disturbances in the synchronized bone-remodeling process.
