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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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

Kaynakça

1. 1) Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22:465–75.
2. 2) McComsey GA, Tebas P, Shane E, Yin MT, Overton ET, Huang JS, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis. 2010;51:937-46.
3. 3) Shiau S, Broun EC, Arpadi SM, Yin MT. Incident fractures in HIV infected individuals: a systematic review and meta-analysis. AIDS. 2013;27:1949-57.
4. 4) Carr A, Grund B, Neuhaus J, Schwartz A, Bernardino JI, White D, et al. Prevalence of and risk factors for low bone mineral density in untreated HIV infection: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med. 2015;16 (Suppl 1):137-46.
5. 5) Tomazic J, Ul K, Volcansek G, Gorensek S, Pfeifer M, Karner P, et al. Prevalence and risk factors for osteopenia/osteoporosis in an HIVinfected male population. Wien Klin Wochenschr. 2007;119(21- 22):639-46. 6) Bonjoch A, Figueras M, Estany C, Peres-Alverez N, Rosales J, del Rio L, et al. High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study. AIDS. 2010;24(18):2827-33.
6. 7) Brown TT, Ruppe MD, Kassner R, Kumar P, Kehoe T, Dobs AS, et al. Reduced bone mineral density in human immunodeficiency virusinfected patients and its association with increased central adiposity and postload hyperglicemia. J Clin Endocrinol Metab. 2004;89(3):1200-6.
7. 8) Groger R, Erin Q, William P. Osteoporosis in HIV-infected patients. Clinical rewievs in bone and mineral metabolism. 2004;2(2):167- 73.
8. 9) Cotter AG, Sabin CA, Simelane S, Macken A, Kavanagh E, Brady JJ, et al. Relative contribution of HIV infection, demographics and body mass index to bone mineral density. Aids. 2014;28(14), 2051-2060.

9. 10) Compston J. HIV infection and bone disease. J Intern Med. 2016;280:350-8
10. 11) Panayiotopoulos A, Bhat N, Bhangoo A. Bone and vitamin D metabolism in HIV. Rev Endocr Metab Disord. 2013;14:119-25.
11. 12) Barbosa N, Costa L, Pinto M. Vitamin D and HIV Infection : a systematic review. Immunod Disord. 2014;3:1.
12. 13) Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc. 2011;86:50–60.
13. 14) Lake JE, Adams JS. Vitamin D in HIV-infected patients. Curr HIV/AIDS Rep. 2011; 8:133–41.
14. 15) Pinzone MR, Di Rosa M, Malaguarnera M, Madeddu G, Focà E, Ceccarelli G, et al. Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic. Eur Rev Med Pharmacol Sci. 2013;17:1218–32.
15. 16) Biver E, Calmy A, Aubry-Rozier B, Birkhäuser M, Bischoff-Ferrari H.A, Ferrari SM, et al. Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporosis Int. 2019;30(5):1125-1135.
16. 17) Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. Aids. 2006;20(17):2165-74
17. 18) Vlot MC, Grijsen ML, Prins JM, de Jongh RT, de Jonge R, den Heijer M, et al. Effect of antiretroviral therapy on bone turnover and bone mineral density in men with primary HIV-1 infection. PLoS One. 2018;13(3):e0193679.
18. 19) Yenilmez E, Çetinkaya RA. Evaluation of initial results of naïve HIV-infected patients regarding bone health. J Surg Med. 2019;384-9.
19. 20) Şenoğlu S, Aydın ÖA. Naif HIV ile Enfekte Bireylerde Kemik Mineral Yoğunluğunun Değerlendirilmesi. Turk J Osteoporos. 2020
20. 21) Womack JA, Goulet JL, Gibert C, et al. Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS One. 2011; 6(2): e17217.
21. 22) McComsey GA, Tebas P, Shane E, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis. 2010; 51(8): 937-46.
22. 23) McComsey GA, Huang JS, Woolley IJ, et al. Fragility fractures in HIV-infected patients: need for better understanding of diagnosis and management. J Int Assoc Physicians AIDS Care (Chic). 2004; 3(3): 86-91
23. 24) Brown TT, Chen Y, Currier JS, Ribaudo HJ, Rothenberg J, Dubé MP, et al. Body composition, soluble markers of inflammation, and bone mineral density in antiretroviral therapy-naive HIV-1 infected individuals. Journal of acquired immune deficiency syndromes. Journal of acquired immune deficiency syndromes (1999). 2013;63(3), 323
24. 25) Çimen C, Aksu-Sayman Ö, Fincancı M. Measurement of bone mineral density in HIV-infected individuals who are not considered as a specific risk group for bone mineral densitometry screening. Klimik Derg. 2019;32(3):318-23.
25. 26) Santi D, Madeo B, Carli F, Zona S, Brigante G, Vescini F, et al. Serum total estradiol, but not testosterone is associated with reduced bone mineral density (BMD) in HIV-infected men: a cross-sectional, observational study. Osteoporosis International. 2016;27(3):1103-14.
26. 27) Mansueto P, Seidita A, Vitale G, Gangemi S, Iaria C, Cascio A. Vitamin D deficiency in hıv ınfection: not only a bone disorder. Biomed Res Int. 2015;2015:735615.
27. 28) Gümüşer F, Arslan F. HIV Pozitif Erkek Hastalarda Osteopeni/Osteoporoz Durumu ve D Vitamini Düzeyleri. FlORA. 2019;24.1: 52-62
28. 29) Ucar F, Yavuz-Taslipinar M, Ozden-Soydas A, Ozcan N. Ankara Etlik İhtisas Eğitim ve Araştırma Hastanesine başvuran hastalarda 25-OH vitamin D düzeyleri. Eur J Basic Med Sci. 2012;2:12-5.
29. 30) Tamer G, Arik S, Tamer I, Coksert D. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid 2011;21:891-6.
30. 31) Aydın OA, Karaosmanoglu HK, Karahasanoglu R, Tahmaz M, Nazlıcan O. Prevalence and risk factors of osteopenia/osteoporosis in Turkish HIV/AIDS patients. Brazilian Journal of Infectious Diseases. 2013;17(6),707-711.