Riassunto analitico
Background Human immunodeficiency virus (HIV) infection has been associated with impaired bone quality and quantity and high fracture risk. In addition, tenofovir disoproxil fumarate (TDF)-containing antiretroviral therapy (ART) regimens were associated with a greater bone loss in HIV patients. Bone loss has been studied in pre and in post-menopausal women living with HIV (WLWH), but never across the menopausal transition assessing both bone mineral density (BMD) and trabecular bone score (TBS).
Objective The aim of the study is to describe pattern of bone quantity and bone quality changes across menopause in WLWH undergoing ART with or without TDF.
Methods We conducted an observational longitudinal retrospective study including WLWH with endocrinologically-defined menopause, attending Modena HIV Metabolic Clinic from January 2012 to May 2019. The observation period was divided into reproductive, transitional, early and late menopause period according to STRAW criteria. These were evaluated for immuno-metabolic abnormalities, comorbidities and bone loss. Lumbar BMD and TBS were derived from DEXA evaluation. We drew a Lowess curve to analyse the impact of menopause and TDF on BMD and TBS. Furthermore, two different GEE model were built to predict changes in BMD and TBS across menopause and TDF-containing ART regimens.
Results 185 Caucasian non-obese (mean age=49.3 years) ART-experienced women were observed for a median of 6.08 years. 134 observations were assessed in the “Reproductive Period”, 180 observations in the “Menopause Transition Period”, 185 in the “Early Menopause Period” and 20 in the “Late Menopause Period”, for a total of 519 DXA observations during the observational period. At baseline, median duration of HIV infection was 244 months and median CD4 cell count was 635 cells/uL and increased during follow-up (p<0.001). LDL, HDL, PCR, vitamin D and PTH significantly increased across menopause, while ASMI, FFMI, lumbar BMD, TBS score and FRAX® score worsened. Waist circumference, time from menopause and calcium concentration were identified as being independent predictors of BMD and TBS changes.
Conclusions This study demonstrates that BMD and TBS were stable in the pre-menopause period and bone loss was more rapid in the early than late menopausal period. Current TDF exposure was not independently associated with neither BMD nor TBS lowering in menopause. The clinical significance of the impact of TDF use during the menopausal transition needs further investigation.
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