HIV/AIDS Hastalarında Osteoporoz/Osteopeni Sıklığı, D Vitamini Düzeyleri ve İlişkili Risk Faktörleri

Abstract

Amaç: İnsan immün yetmezlik virüsü (HIV) ile enfekte bireylerde kemik mineral yoğunluğunda (KMY) azalma sık görülmekte ve osteopeni, osteoporoz oranı ile kemiklerde kırık riski genel popülasyona göre daha yüksek seyretmektedir. Çalışmamızda çift enerjili X-ışını absorbsiyometrisi (DXA) sonucuna göre hastalarımızın osteoporoz/osteopeni sıklığı ve ilişkili risk faktörlerinin irdelenmesi, 25 (OH) vitamin D sonuçlarının değerlendirilmesi hedeflendi. Materyal ve Metod: Kliniğimizde 2011-2021 tarihleri arasında takip ettiğimiz HIV ile enfekte hastaların dosyaları geriye dönük olarak incelendi. DXA sonucuna ve 25 (OH) vitamin D düzeyine ulaşılan hastalar çalışma kapsamında değerlendirildi. Olguların yaş, cinsiyet, bulaş şekli, sigara kullanımı, CD4 T lenfosit düzeyleri, HIV RNA seviyeleri KMY sonuçlarına göre karşılaştırıldı. Bulgular: KMY sonucuna ulaşılan 146 hastanın yaş ortalaması 44, CD4 T lenfosit ortalaması 399 idi. Hastaların 9 (%6)’unda osteoporoz, 44 (%30)’ünde osteopeni saptandı. Osteoporoz/osteopeni saptanan hastaların % 49’u 50 yaş altında idi. Cinsiyet, CD4 T lenfosit sayısı, HIV viral yük açısından osteoporoz/osteopeni ile KMY normal olan grup arasında istatistiksel anlamlı fark saptanmadı. 25 (OH) vitamin D düzeyleri, 0-20 arasında olanlar 85/116 (%73), 21-30 arasında olanlar 24/116 (%20), 30’un üzerinde olanlar 7/116 (%6) bulundu. Sonuç: Çalışmamızda, HIV ile enfekte hastalarımızın önemli bir kısmında KMY’de azalma ve ciddi D vitamin eksikliği saptanmıştır. Özellikle tarama önerilmeyen genç hasta grubunda da osteoporoz/osteopeni insidansının yüksek olduğu gözden kaçırılmamalıdır. D vitaminin immünmodülatör ve kemik sağlığında ki etkileri göz ardı edilmeden eksikliğin olduğu hastalara replasman tedavilerinin uygulanması gerektiğini düşünmekteyiz.

Keywords

• osteopeni; osteoporoz
• 25 (OH) vitamin D
• HIV

Frequency of Osteoporosis/Osteopenia, Vitamin D Levels and Associated Risk Factors in HIV/AIDS Patients

Abstract

Background: Decrease in bone mineral density (BMD) is common in individuals infected with human immune deficiency virus (HIV) and the rate of osteopenia, osteoporosis and bone fracture risk are higher than the gene-ral population. In our study, we aimed to evaluate the frequency of osteoporosis/osteopenia according to the results of dual-energy X-ray absorptiometry (DXA) and examination of associated risk factors and also evaluate the results of 25 (OH) vitamin D.
Materials and Methods: The files of HIV-infected patients we followed up in our clinic between 2011 and 2021 were retrospectively reviewed. Patients with DXA results and 25 (OH) vitamin D levels were evaluated within the scope of the study. Age, gender, mode of transmission, smoking, CD4 T lymphocyte levels, HIV RNA levels of the cases were compared according to BMD results.
Results: The average age of 146 patients with BMD results was found 44, and the CD4 T lymphocyte was 399. Osteoporosis was diagnosed in nine (6%) patients and osteopenia was diagnosed in 44 (30%) patients. 49% of patients diagnosed as osteoporosis/osteopenia were under the age of 50. There was no statistically significant difference between the osteoporosis/osteopenia group and the group with normal BMD in terms of gender, CD4 T lymphocyte count and HIV viral load. 25 (OH) vitamin D levels were found as 85/116 (73%) between 0-20, 24/116 (20%) between 21-30 and 7/116 (6%) above 30.
Conclusions: In our study, a significant decrease in BMD and severe vitamin D deficiency were found in a signifi-cant portion of our HIV-infected patients. Especially in young patient group for whom screening is not recom-mended. It should be considered that the incidence of osteoporosis/osteopenia may be high. Without ignoring the effects of vitamin D on immunomodulatory and bone health, we think replacement therapy should be applied to patients with deficiency.

Keywords: Osteopenia, Osteoporosis, 25(OH)vitamin D, HIV

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