Low bone mass and vitamin D in Brazilian people living with HIV under antiretroviral therapy

25(OH)D concentrations are not associated with adiposity indicators, but with the stage of immunodeficiency in people with HIV/AIDS

Introduction

Objective: this study assessed the association between serum 25(OH)D concentrations and anthropometric indicators of adiposity in people living with HIV/AIDS taking highly active antiretroviral therapy. Methods: the study included 244 people living with HIV/AIDS who received outpatient care at the Institute of Tropical Diseases in the city of Teresina, Brazil. Sociodemographic, clinical, anthropometric and laboratory characteristics were examined. Serum 25(OH)D was analyzed by high-performance liquid chromatography in accordance with the Vitamin D Standardization Program. Multiple linear regression analysis adjusted for gender, age, disease stage and duration of highly active antiretroviral therapy was performed to assess the association between 25(OH)D concentrations and adiposity indicators. Results: the study included 142 (58.2 %) men and 102 (41.8 %) women, with a mean (± SD) age of 39.13 (± 10.83) years. A proportion of 57.8 per cent of the participants had insufficient concentrations of 25(OH)D below 30 ng/mL. Individuals in more advanced stages of immunodeficiency had lower concentrations of 25(OH)D (30.30 ± 16.10 ng/mL) compared to those with mild immunodeficiency or no immunodeficiency. There was no significant association between 25(OH)D concentrations and any of the adiposity indicators considered in this study. Conclusion: vitamin D concentrations in people living with HIV/AIDS using antiretroviral therapy are related to the degree of immunosuppression, but not to the individual's adiposity status.

Sarcopenic obesity and reduced BMD in young men living with HIV: body composition and sex steroids interplay

PURPOSE

Sex steroids play a key role on male bone homeostasis and body composition (BC), their role in men living with HIV (MLWH) is less recognized. This study aimed at investigating the prevalence of low BMD, sarcopenia, and sarcopenic obesity (SO) and their relationship with sex steroids in MLWH aged < 50.

METHODS

Prospective, cross-sectional, observational study on MLWH younger than 50 (median age 47.0 years). BC and BMD were evaluated with DXA. Two different definitions of sarcopenia were applied: appendicular lean mass/height2 (ALMI) < 7.26 kg/m2 or appendicular lean mass/body weight (ALM/W) < 28.27%. Low BMD was defined for Z-score < -2.0. Sarcopenia coupled with obesity identified SO. Serum total testosterone (T) and estradiol (E2) were measured by LC-MS/MS; free testosterone (cFT) was calculated by Vermeulen equation.

RESULTS

Sarcopenia was detected in 107 (34.9%) and 44 (14.3%) out of 307 MLWH according to ALMI and ALM/W, respectively. The prevalence of SO was similar by using both ALMI (11.4%) and ALM/W (12.4%). Sarcopenic and SO MLWH had lower total T and cFT in both the definition for sarcopenia. BMD was reduced in 43/307 (14.0%). Serum E2 < 18 pg/mL was an independent contributing factor for sarcopenia, SO, and low BMD.

CONCLUSIONS

T and E2 are important determinants of BC even in MLWH. This is among the first studies investigating the distribution of obesity phenotypes and the prevalence of SO among MLWH showing that SO is present in 11-12% of enrolled MLWH regardless of the definition used. However, deep differences emerged using two different diagnostic definitions.

Factors Associated with Periodontitis in Patients with and without HIV

Purpose

The aim of this study was to compare clinical periodontal conditions in HIV-positive people on HAART with an HIV-negative group, in addition to investigating factors associated with periodontitis in the entire sample.

Methods

This was a cross-sectional study. Data were collected by oral clinical examination for the diagnosis of periodontitis, review of medical records, and application of a questionnaire containing personal data, deleterious habits, and oral hygiene habits for the other variables. The results were analyzed by Pearson's χ ² test and Student's t-test. A logistic regression model was constructed for the multivariate analysis and periodontitis was defined as a dependent variable. The analysis was performed on the entire sample (HIV+ and HIV-) and also on the group consisting of only people living with HIV.

Results

Individuals older than 43 years old and with HIV were more likely to develop moderate and severe periodontitis (47.80 and 4.84 times, respectively). When analyzing only HIV+, in addition to age (OR = 2.795; CI = 1.080-7.233), the use of nonnucleoside reverse transcriptase inhibitors (NNRTIs) (OR = 2.841; CI = 1.135-7.112) was also associated with moderate and severe periodontitis.

Conclusion

It was possible to observe a higher prevalence of periodontitis among individuals with HIV, showing an association between the virus, advanced age, and moderate or severe periodontitis.