Abstract: SA-PO881

HIV/AIDS Is Associated with Bone Histomorphometric Abnormalities before Antiretroviral Therapy

Session Information

  • Mineral Disease: CKD-Bone
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

  • 1203 Mineral Disease: CKD-Bone

Authors

  • Ramalho, Janaina de Almeida Mota, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
  • Martins, Carolina Steller wagner, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  • Galvão, Juliana Costa de oliveira, Universidade Nove de Julho, São Paulo, Brazil
  • Pereira, Rosa M., Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
  • Nickolas, Thomas, Columbia University Medical Center, New York, New York, United States
  • Yin, Michael T., Columbia University Medical Center, New York, New York, United States
  • dos Reis, Luciene, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
  • Jorgetti, Vanda, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  • Moyses, Rosa M.A., Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
Background

The reduction in bone mineral density (BMD) is a known metabolic complication of antiretroviral therapy (ART), especially tenofovir, which may cause tubular dysfunction, excess phosphaturia and osteomalalcia. Low BMD and increased fracture risk, however, has been recognized in patients with HIV/AIDS even before treatment initiation. We aimed to identify and describe abnormalities in bone histomorphometry in ART-naïve HIV patients.

Methods

In 20 male patients with HIV infection, ART-naïve, we evaluated bone structure, turnover and mineralization by iliac crest bone biopsy with histomorphometry. Main exclusion criteria were eGFR < 60ml/min/1,73m2, metabolic bone disease, cirrhosis, diabetes, and medications affecting bone metabolism. HIV viral load and CD4+ T cell count (CD4) were determined. Serum 25 vitamin D (25vitD), PTH and RANKL levels were measured. BMD was assessed by DXA.

Results

Mean age was 29.6 ± 5.5 years, mean BMI was 24.7 ± 2.4, median time since diagnosis of HIV infection was 87 ( 71 – 231) days, with median viral load of 29,945 (IQR 5,485 – 53,118) copies/mL and mean CD4 of 375 ± 200 cells. Mean 25vitD was 22.3 ± 7.9 ng/ml and PTH was within reference range in all patients. RANKL levels correlated positively with HIV viral load (r = 0.48, p = 0.04) and negatively with CD4 (r -0.65, p =0.003). Three patients (15%) had low BMD (Z score ≤ -2) at any site. By histomorphometry, 20% had low bone trabecular volume and 25% had decreased cortical thickness, whereas cortical porosity was normal in all of them. Decreased bone formation rate was seen in 80% and abnormal mineralization was detected in 60%. Increased osteoclastic and eroded surface were seen in 40 and 30%, respectively.

Conclusion

Abnormalities in bone volume, turnover and mineralization are common among HIV-infected persons, especially decreased formation and mineralization, even before ART exposure. Immune dysregulation, mediated by abnormalities in RANKL levels, may contribute. Further study is necessary to determine which factors (immunologic, hormonal or others) predict greater bone loss with ART initiation.

Funding

  • Government Support - Non-U.S.