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Is bone loss linked to chronic inflammation in antiretroviral-naive HIV-infected adults? A 48-week matched cohort study

Hileman, Corrilynn O.a,b; Labbato, Danielle E.a,c; Storer, Norma J.a,c; Tangpricha, Vind; McComsey, Grace A.a,c

doi: 10.1097/QAD.0000000000000320
Clinical Science

Objective: Antiretroviral therapy (ART) has been implicated in bone loss in HIV. The role of inflammation and vitamin D is unclear and better investigated in ART-naive individuals.

Design and methods: This is a 48-week, prospective cohort study to compare baseline and change in hip and spine bone mineral density (BMD) measured by dual-energy X-ray absorptiometry in HIV-infected, ART-naive adults and healthy controls matched by age, sex, and race. We also studied associations between bone loss and inflammation markers and plasma 25-hydroxyvitamin D [25(OH)D] using logistic regression.

Results: Forty-seven HIV-infected adults and 41 controls were included. Baseline 25(OH)D, BMD at total hip, trochanter, and spine, and prevalence of osteopenia and osteoporosis were similar between groups. In the HIV-infected group, total hip and trochanter, but not spine, BMD decreased over 48 weeks [hip −0.005 (−0.026–0.008) g/cm2, P = 0.02 within group; trochanter −0.013 (−0.03–0.003), P < 0.01]. BMD did not change at any site within controls. The HIV-infected group was more likely to have bone loss at the trochanter (P = 0.03). This risk persisted after adjustment for age, sex, race, BMI, smoking, and hepatitis C (odds ratio 4, 95% confidence interval 1.2–15.8). In the HIV-infected group, higher interleukin-6 concentrations (P = 0.04) and Caucasian race (P < 0.01) were independently associated with progression to osteopenia or osteoporosis, but not 25(OH)D levels.

Conclusion: BMD at the total hip and trochanter sites decreased in the HIV-infected, ART-naive adults, but not controls, over this 48-week study. Higher serum interleukin-6 concentrations were associated with progression to osteopenia or osteoporosis status in the HIV-infected group.

aCase Western Reserve University School of Medicine

bMetroHealth Medical Center

cUniversity Hospitals Case Medical Center, Cleveland, Ohio

dEmory University School of Medicine, Atlanta, Georgia, USA.

Correspondence to Grace A. McComsey, MD, Professor of Pediatrics and Medicine, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA. Tel: +1 216 844 3607; fax: +1 216 844 8362; e-mail:

Received 13 January, 2014

Revised 22 April, 2014

Accepted 24 April, 2014

© 2014 Lippincott Williams & Wilkins, Inc.