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Aging attenuates the association between coronary artery calcification and bone loss among HIV-infected persons

Escota, Gerome, MD*,1; Baker, Jason, MD2; Bush, Tim, BA3; Conley, Lois, MPH3; Brooks, John T., MD3; Patel, Pragna, MD3; Powderly, William, MD1; Presti, Rachel, MD PhD1; Overton, E. Turner, MD4 for the CDC (Centers for Disease Control and Prevention)-SUN (Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy) Investigators

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 06, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002092
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Introduction: Studies among HIV-uninfected persons (mostly in their sixth decade of life) show that detectable coronary artery calcium (CAC) is independently associated with low bone mineral density (BMD), suggesting a possible common pathogenic mechanism.

Aim: We assessed the relationship between CAC and BMD, which has not been well described among younger to middle-aged HIV-infected persons.

Methods: We studied participants with baseline CAC and BMD measures from a prospective cohort of HIV-infected persons enrolled in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) during 2004-2006. We used logistic regression to assess the association between detectable CAC (>0 Agatston score) and BMD (g/cm2, T-score), and adjusted for known traditional and HIV-related risk factors.

Results: Among 472 participants (76% male, 30% non-Hispanic black, median age 41 years, 71% with HIV RNA <400 copies/mL), the majority had no detectable CAC (82%), but had baseline osteopenia (53%) or osteoporosis (10%). In univariate analysis, participants with detectable CAC had lower femoral neck/total hip T-scores, lower femoral neck/total hip/lumbar spine BMD, and higher rates of osteopenia/osteoporosis. After adjustment for age, all associations were no longer significant; adjustment for traditional risk factors excluding age and HIV-related variables failed to attenuate these associations.

Conclusions: We found aging attenuates the association between detectable CAC and BMD in this cohort. Aging remains an important contributor to non-AIDS-defining illnesses. These data reinforce the importance of developing screening and prevention strategies for ageing HIV-infected persons given their excess risk across a wide spectrum of end-organ complications.

1Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri

2Department of Infectious Diseases, Hennepin County Medical Center, University of Minnesota, Minneapolis

3Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

4Division of Infectious Diseases, University of Alabama School of Medicine, Birmingham, Alabama

Corresponding author: escotag@wustl.edu

The authors report no conflicts of interest related to this work.

Financial Support: Centers for Disease Control and Prevention contract numbers 200-2002-00610, 200-2002-00611, 200-2002-00612, 200-2002-00613, 200-2007-23633, 200-2007-23634, 200-2007-23635, and 200-2007-23636

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