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de Gusmão MBF, de Oliveira VV, Santos NMDS, Melo LC. Assessing bone mineral density in children and adolescents living with HIV and on treatment with tenofovir disoproxil fumarate: a systematic review. Rev Paul Pediatr 2023; 42:e2023042. [PMID: 37971172 PMCID: PMC10637732 DOI: 10.1590/1984-0462/2024/42/2023042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To investigate the impact of tenofovir disoproxil fumarate on bone mineral density and bone mineral content in children and adolescents infected with the human immunodeficiency virus. DATA SOURCE The search procedure was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. The search was carried out until April 2022 in Medical Literature Analysis and Retrieval System Online (Medline), Embase, Cochrane Central, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, and MedRxiv. The combination of terms used was: (Children OR Youth OR Teenagers) AND HIV AND (Tenofovir OR "Antiretroviral therapy") AND ("Bone density" OR Osteoporosis OR Osteopenia). The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022312851). DATA SYNTHESIS The initial searches resulted in 1156 papers. After the exclusion of duplicate studies, three blinded reviewers analyzed the title and abstract of 563 papers, of which 57 remained to be read in full. Only nine papers met the eligibility criteria and were included in descriptive and risk-of-bias analyses. Regarding study design, four were cross-sectional, three were longitudinal before-after studies without a control group, and two were prospective cohorts. Among these nine papers, seven showed no significant association between tenofovir disoproxil fumarate use and reduced bone mass in young people. However, these papers did not have high methodological quality. CONCLUSIONS Although most of the selected papers found no harmful effect of tenofovir disoproxil fumarate on bone mass, further primary research with higher methodological quality is needed so robust scientific evidences can be obtained.
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Affiliation(s)
| | | | | | - Luciana Costa Melo
- Universidade Federal de AlagoasMaceióALBrasilUniversidade Federal de Alagoas, Maceió, AL, Brasil.
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Vizcarra P, Moreno A, Vivancos MJ, Muriel García A, Ramirez Schacke M, González-Garcia J, Curran A, Palacios R, Sánchez Guirao AJ, Reus Bañuls S, Moreno Guillén S, Casado JL. A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model. J Bone Miner Res 2023; 38:1443-1452. [PMID: 37545089 DOI: 10.1002/jbmr.4894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long-term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as nontraumatic or those occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61 to 5.22) per 1000 person-years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the 5- and 10-year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722 to 0.814) and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long-term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and could potentially replace the current tools recommended for fracture risk assessment in this population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Pilar Vizcarra
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María J Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel García
- Unit of Biostatistics, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red, Epidemiología y Salud Pública (CIBERESP), Universidad de Alcalá, Madrid, Spain
| | - Margarita Ramirez Schacke
- Unit of Infectious Diseases - HIV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan González-Garcia
- Unit of VIH, Department of Internal Medicine II, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Adrián Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | - Sergio Reus Bañuls
- Unit of Infectious Diseases, ISABIAL, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Santiago Moreno Guillén
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José L Casado
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Tasca KI, Fagundes Vidal VVM, Martinez Manfio V, Naime Barbosa A, de Souza LDR. Contributory role of ART in the development of non-AIDS comorbidities in asymptomatic PLWHA. J Appl Biomed 2021; 19:73-82. [PMID: 34907718 DOI: 10.32725/jab.2021.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the many benefits that follow antiretroviral therapy (ART) initiation, its chronic use contributes to the early aging of people living with HIV/AIDS (PLWHA). The aim of this cross-sectional study was to trace the prevalence of and investigate possible renal, bone and metabolic changes, as well as cardiovascular risk in 94 asymptomatic PLWHA, relating them to the duration of ART use. METHODS Four groups were evaluated according to ART use: G1 (n = 21), ART-naïve individuals; G2 (n = 17), <2 years; G3 (n = 40), 2-10 years; and G4 (n = 16) on ART for more than 10 years. RESULTS Our results showed a high prevalence of dyslipidemic individuals (64%), especially in those under ART. Lower creatine phosphokinase levels were observed in G1 as compared to the others (p < 0.05). Regarding the Framingham score, 12.1% of PLWHA showed moderate and high risk, and the highest proportion (38.5%) occurred in G4 (p = 0.003). A decrease in glomerular filtration rates occurred in 20% of patients, which was also more significant in G3 and G4 (p = 0.007). High prevalences of osteopenia and osteoporosis (53.2%) were found, especially in G1 and G4; however, G1 showed the lowest means for alkaline phosphatases (AP, p = 0.04 and BAP, p = 0.005) and osteocalcin (p = 0.005), in addition to higher vitamin-D concentrations (p = 0.04). CONCLUSIONS Our study showed the possible contributory role of ART in these changes, which leads us to reflect on the need for specific conducts and patient care, pointing out the importance of individualized care in an attempt to increase life expectancy.
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Affiliation(s)
- Karen Ingrid Tasca
- Sao Paulo State University - UNESP, Institute of Biosciences of Botucatu, Department of Microbiology and Immunology, Botucatu, Sao Paulo State, Brazil
| | - Vania V M Fagundes Vidal
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil
| | - Vanessa Martinez Manfio
- Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Alexandre Naime Barbosa
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Lenice do Rosario de Souza
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
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Ozcan SN, Sevgi DY, Oncul A, Gunduz A, Pehlivan O, Terlemez R, Kuran B, Dokmetas L. The prevalence and associated factors of reduced bone mineral density (BMD) among men with suppressed viral load taking antiretroviral therapy. Curr HIV Res 2021; 20:74-81. [PMID: 34856908 DOI: 10.2174/1570162x19666211202100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/02/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reduced bone mineral density (BMD) is a frequent comorbidity observed in people living with HIV (PLHIV). OBJECTIVE The aim of the study is to determine the prevalence and associated factors of reduced bone mineral density (BMD) among men with suppressed viral load taking antiretroviral therapy. METHOD The study was conducted as a cross-sectional study design between January to April 2019. 211 patients were included in the study. Z-score at either body site between -1.0 and -2.0 or -2 or less were defined as osteopenia or osteoporosis, respectively. Multivariate logistic regression analysis was used to evaluate the factors affecting the development of reduced BMD. RESULTS The mean age of the patients involved in the study was 34.8 ± 7.6. Osteoporosis was detected in 21.4% and osteopenia in 44.5% of the patients. There was a significant relationship between HIV diagnosis time, ART usage duration, tenofovir disoproxil fumarate (TDF) use, TDF use in the past, total TDF usage time and decreased BMD. Multivariate logistic regression analysis showed that the likelihood of reduced bone marrow density was 67% lower among those with regular milk or dairy product intake compared to those without (OR=0.330; 95% CI = 0.12-0.92, p=0.033 ) Conclusion: There is a high prevalence of reduced BMD among PLHIV aged under 50 which is mainly confounded by HIV diagnosis time, ART usage duration and TDF usage. Although virological control has been achieved, these patients should be followed up, considering that they may have decreased BMD.
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Affiliation(s)
- Safiye Nur Ozcan
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Dilek Yıldız Sevgi
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Ahsen Oncul
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Alper Gunduz
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Ozgun Pehlivan
- University of Abant Izzet Baysal , Department of Public Health, Bolu. Turkey
| | - Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul. Turkey
| | - Banu Kuran
- Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul. Turkey
| | - Llyas Dokmetas
- University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, İnfectious Diseases and Clinical Microbiology, Istanbul. Turkey
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Abstract
Immune imbalance caused bone loss. Osteoimmunology is emerging as a new interdisciplinary field to explore the shared molecules and interactions between the skeletal and immune systems. In particular, T lymphocytes (T cells) play pivotal roles in the regulation of bone health. However, the roles and mechanisms of T cells in the treatment of osteoporosis are not fully understood. The present review aims to summarize the essential regulatory roles of T cells in the pathophysiology of various cases of osteoporosis and the development of T cell therapy for osteoporosis from osteoimmunology perspective. As T cell-mediated immunomodulation inhibition reduced bone loss, there is an increasing interest in T cell therapy in an attempt to treat osteoporosis. In summary, the T cell therapy may be further pursued as an immunomodulatory strategy for the treatment of osteoporosis, which can provide a novel perspective for drug development in the future.
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Affiliation(s)
- Wenjuan Zhang
- Lab for Bone Metabolism, Xi'an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Kai Dang
- Lab for Bone Metabolism, Xi'an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Ying Huai
- Lab for Bone Metabolism, Xi'an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Airong Qian
- Lab for Bone Metabolism, Xi'an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
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