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Bone Density Lower With Than Without HIV in People 50 or Older
  16th European AIDS Conference, October 25-27, 2017. Milan
Mark Mascolini
Older people with HIV had lower bone mineral density (BMD) than younger people with HIV or older people without HIV, according to multivariable analysis of a 1293-person cohort in England and Ireland [1]. An analysis limited to people with HIV linked antiretroviral therapy (ART), higher current CD4 count, and undetectable viral load to lower BMD.
Research continues to find high rates of low BMD in diverse HIV populations. But POPPY Study researchers who conducted this new analysis noted that not all studies agree on low-BMD risk factors in people with HIV [2,3], and some studies see no BMD difference with versus without HIV after statistical adjustment for weight and smoking [4,5].
The POPPY Study aims to explore the impact of aging on clinical outcomes in HIV-positive people in England and Ireland. This analysis compared BMD in three groups: older people with HIV, older people without HIV, and younger people with HIV. POPPY includes those three groups: (1) people 50 or older who acquire HIV sexually, (2) younger HIV-positive people frequency-matched to the older group by gender, ethnicity, sexuality, and location (in or out of London), and (3) HIV-negative people 50 or older frequency-matched to the older HIV group by age, gender, ethnicity, sexuality, and location.
POPPY participants had DXA scans to measure BMD at the lumbar spine and femoral neck. The investigators used linear regression analysis to identify associations between study groups and BMD at each site, before and after statistical adjustment for possible confounding variables detailed below.
The older HIV group, younger HIV group, and older non-HIV group included 649, 353, and 291 participants. Respective proportions of women were 11.7%, 20.1%, and 37.1% and of blacks 13.4%, 20.7%, and 10.7%. Gay/bisexual men made up larger proportions of the older HIV group (79.4%) and the younger HIV group (71.4%) than the older HIV-negative group (45.7%). And median BMI was slightly lower in the older HIV group (26 kg/m2) and the younger HIV group (25 kg/m2) than in the older HIV-negative group (27 kg/m2). The older and younger HIV groups had higher proportions of current smokers (21.7% and 29.2%) than the older HIV-negative group (13.8%), higher proportions who recently used recreational drugs (25.1% and 33.4% versus 11.7%), and higher proportions with hepatitis B surface antigen or hepatitis C antibody. About 90% of both HIV groups had a viral load below 50 copies, and both groups had a median CD4 count above 600.
BMD was significantly lower in HIV-positive people 50 or older than in younger people with HIV or similarly aged people without HIV, at both the lumbar spine and femoral neck (P < 0.001 for both). Multivariable analysis adjusted for demographic and lifestyle variables confirmed lower lumbar spine BMD in the older HIV group than in the younger HIV group (beta-coefficient 0.027, 95% confidence interval [CI] 0.003 to 0.050) or the older HIV-negative group (beta 0.076, 95% CI 0.047 to 0.106) (P = 0.001). In the same kind of analysis, femoral neck BMD was significantly lower in the older HIV group than in the younger HIV group (beta 0.055, 95% CI 0.034 to 0.076) or the older HIV-negative group (beta 0.062, 95% CI 0.036 to 0.089) (P = 0.001). These analyses adjusted for race, gender, sexuality, BMI, smoking status, recent recreational drug use, and HBV and HCV coinfection.
Among people with HIV, current ART, current viral load below 50 copies, and higher current CD4 count all tended toward association with lower BMD at both the lumbar spine and femoral neck. Multivariable analysis adjusted for the factors listed in the previous paragraph plus current ART and CD4 count confirmed lower BMD in the older HIV group than the younger HIV group at the lumbar spine (beta 0.025, 95% CI 0.001 to 0.048, P = 0.001) and the femoral neck (beta 0.055, 95% CI 0.033 to 0.076, P = 0.001).
The POPPY investigators reminded colleagues that the cross-sectional and observational design of this analysis precludes drawing conclusions about causality. They stressed that their population underrepresents women and nonwhites and excludes drug injectors.
1. Bagkeris E, Cotter A, Post F, et al. The contribution of HIV to reduced bone mineral density (BMD): the POPPY Study. 16th European AIDS Conference. October 25-27, 2017. Milan. Abstract PS2/3.
2. Yin MT, McMahon DJ, Ferris DC, et al. Low bone mass and high bone turnover in postmenopausal human immunodeficiency virus-infected women. J Clin Endocrinol Metab. 2010;95:620-629.
3. Cotter AG, Sabin CA, Simelane S, et al. Relative contribution of HIV infection, demographics and body mass index to bone mineral density. AIDS. 2014;28:2051-2060. 4. Bolland MJ, Grey AB, Gamble GD, Reid IR. Low body weight mediates the relationship between HIV infection and low bone mineral density: a meta-analysis. J Clin Endocrinol Metab. 2007;92:4522-4528.
5. Kooij KW, Wit FW, Bisschop PH, et al. Low bone mineral density in patients with well-suppressed HIV infection: association with body weight, smoking, and prior advanced HIV disease. J Infect Dis. 2015;211:539-548.