HIV patients on antiretroviral therapy (HAART): Bone mass loss and lipodystrophy/lipoatrophy correlation

Objectives We further investigated whether a relationship between osteopenia/osteoporosis and lipodystrophy/lipoatrophy in HIV patients on HAART exists.

Methods We studied 82 consecutive HIV male patients on HAART (treatment duration: 42.4±13.3 mths) with normal BMI. Body fat alterations were identified at face, neck, trunk and extremities and classified as: lipoatrophy (LA: 19 patients), lipodystrophy (LD: 26 patients), no fat changes (NFC: 37 patients). In all patients we measured by DEXA: 1) BMD (gr/cm2) in lumbar spine with T score calculation, classifying the patients, according to WHO criteria, as normal with T score ≥-1, osteopenic with T score between -1 and -2.5, osteoporotic with T score ≤-2.5; 2) FAT mass (FM), both in the trunk (T) and in appendicular (A) regions with T/A ratio calculation.

Results Low BMD values were ascertained in 56/82 (68.3%) of patients, with osteoporosis in 18/82 (21.9%) and with osteopenia in 38/82 (46.3%); the difference between LD (38.5%) and NFC (13.5%) was significant (p<0.05) only for osteoporosis, all LD patients including protease inhibitors (PI) in their therapeutic regimen. BMD was lower in LD cases than in LA and NFC, but not significantly. LD patients had significantly (p<0.01) higher T-FM than LA and NFC: LA had significantly (p<0.05) A-FM than LD and NFC, while LD and NFC did not show any difference. T/A ratio was significantly higher in LD than in NFC and in LA as well as it was in LA than NFC. BMD negatively correlated with T-FM values and A-FM with both PI and NRTI therapy duration; T/A ratio was positively correlated with PI therapy duration.

Conclusions In our HIV patients on HAART bone mass loss occurs with osteoporosis frequency significantly higher when lipodystrophy and central-fat accumulation were present and PI was included in the therapeutic regimen. An inverse correlation seems to exist between T-FM and BMD, but it is not clear whether the pathogenetic mechanism leading to central fat accumulation and bone mineral loss is common