Bone health and vitamin D status in Thai HIV-1 infected and uninfected adults

Project no.: TNT 003.1 (NCT01634607)

This study will compare and assess the prevalence of osteopenia and vitamin D deficiency as well as effects of TDF on the patients’ bone among HIV positive and negative patients.

Results: There are limited studies regarding bone health among human immunodeficiency virus (HIV)-infected patients from Asian countries. We compared bone mineral density (BMD), vitamin D status and bone markers among antiretroviral therapy (ART) naive HIV-infected Thais compared to HIV uninfected controls from 3 sites in Thailand. Healthy subjects (free of diabetes, hypertension, and active opportunistic infection (OI)) aged ≥ 30 years, with and without HIV infection were enrolled. BMD at the lumbar spine (L1 to L4), femoral neck, and total hip as well as percentage of body fat were measured using Hologic DXA at baseline and at 5 years. For this analysis, the data of BMD, serum 25-hydroxyvitamin D (25(OH)D) levels, and bone turnover markers (serum procollagen type 1 N-terminal propeptide (P1NP), osteocalcin (OC) and C-terminal cross-linking telopeptide of type I collagen (CTX)) at the patients’ baseline visit of 571 participants (170 HIV-infected men, 127 HIV-uninfected men, 132 HIV-infected women and 142 HIV-uninfected women) were included.HIV-infected patients were 1.5 years younger (men: 39.7 ± 6 vs. 41.3 ± 6 yr; women: 39.5 ± 4 vs. 41.2 ± 5 yr) and had lower BMI. Compared to HIV-uninfected controls, HIV-infected patients had higher mean serum 25-hydroxyvitamin D level but this was not correlated with BMD. There were no differences in the actual BMD between subjects with and without HIV. Interestingly, the markers for bone formation, serum P1NP and osteocalcin were significantly lower in HIV-infected patients, particularly those with low CD4 count. Only few participants were classified as having low bone mass and there was no reported fracture in any of the participants.Middle-aged Thai patients with HIV infection, who were not yet on ART, did not have lower BMD or lower vitamin D levels compared to HIV-uninfected controls. However, they had lower bone formation markers, particularly those with low CD4 count. This finding supports the benefit of early ART.