Prevalence of osteoporosis in HIV infected patients initiating antiretroviral drugs living in Johannesburg
Date
2024
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Abstract
Background: Low-energy fractures complications are a major public health issue that make osteoporosis even worse. In sub-Saharan Africa, the prevalence of osteoporosis varies from 18.2% to 65.8%. In wealthy nations, it affects one-third of white women over 50. There was no change in bone mineral density (BMD) between HIV-infected and non-HIV-infected women in Sub-Saharan Africa, where human immunodeficiency virus (HIV) is widespread. Other investigations that demonstrated that HIV-infected people had poor BMD both before and after starting anti-retroviral treatment did not consistently show a low BMD finding. Inflammation-mediated bone remodelling has been associated with low BMD in HIV-infected patients. Antiretroviral Therapy (ART) has been demonstrated to exacerbate bone loss in addition to the pre-existing intrinsic risk of developing osteoporosis. Nucleoside reverse transcriptase (Tenofovir) has been shown to cause the most significant bone loss, followed by protease inhibitors (Lopinavir/Ritonavir). On the other hand, integrase inhibitor (Raltegravir) has the least noticeable effects on BMD, despite its pathophysiological causes of decreased BMD in patients on ART being poorly understood. Research question: Is there loss of bone in HIV-infected patients before initiating ART?
Methodology: The case files of patients who were HIV-positive and enrolled in the ADVANCE research were retrospectively reviewed on a desk. All of the 1053 individuals in the ADVANCE research had a DXA scan performed to evaluate BMD as part of the initial screening and recruitment approach. The ADVANCE research enrolled HIV-positive people and randomly assigned them to three ART arms. The original pre-treatment data points on bone mineral density were used in this study to respond to the research question.
Results: A total of 400 black patients were reviewed. Of these 400 records reviewed, 62.3% were female. The female to male ratio was 1.6:1. Eighty percent of the participants were younger than 40 years old, and only 3% were older than 50 years. Eighty two percent were virally suppressed with less than 50 viral copies. The prevalence of osteopenia was 25.5% and osteoporosis was 2.8%, observed in predominantly African female participants aged between 30 and 39 years.
Conclusion: The findings of this study confirm that there is pre-existing bone loss among HIV-infected ART naïve individuals. Approximately twenty eight percent (28.3%) in our study v had clinically confirmed evidence of bone loss and of these, 2.8% of the entire cohort had osteoporosis. Bone loss was most prevalent in black females who are virologically suppressed.
Description
A research report submitted in partial fulfilment of the requirement for the degree of Master of Medicine (MMed) in Orthopeadic Surgery to the Faculty of Health Sciences, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, 2023
Keywords
Osteoporosis, HIV infected patients, Bone loss