High prevalence of radiological vertebral fractures in HIV-infected males
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Age-related co-morbidities including osteoporosis are relevant in patients responding to combination antiretroviral therapy (cART). Vertebral fractures are common osteoporotic fractures and their diagnosis is useful for managing at-risk individuals. However, there are few data from HIV-infected patients. Therefore, the aim of this study was to determine the prevalence of and factors associated with vertebral fractures in a population of HIV-infected males. A cross-sectional study of 160 HIV-infected patients with available chest X-rays was conducted from 1998 to 2010. One hundred and sixty-three males with comparable age and with no history of HIV infection were recruited as controls. Semi-quantitative evaluation of vertebral heights in lateral chest X-rays and quantitative morphometry assessment of centrally digitized images using dedicated morphometry software were utilized to detect prevalent vertebral fractures. The result showed that the vertebral fractures were detected in 43/160 (26.9%) HIV-infected patients and in 21/163 (12.9%) controls (P = 0.002). In HIV-infected patients with fractures, 27 had two or more fractures and ten patients had severe fractures. The prevalence of any fractures and multiple fractures in HIV-infected patients receiving cART (29.6 and 20.0%) was slightly higher than in HIV-infected patients not exposed to cART (17.1 and 5.7%), but significantly higher than control subjects (12.9 and 3.7%). At multivariable analyses, body mass index and diabetes mellitus were independently correlated with vertebral fractures in HIV-infected patients. We concluded that a significant proportion of HIV-infected males receiving cART showed vertebral fractures. Furthermore, proactive diagnosis of vertebral fragility fractures is particularly relevant in patients who are overweight or suffer from diabetes.
KeywordsVertebral fracture HIV Antiretroviral therapy Osteoporosis
We thank Alfredo Scalzini MD, Filippo Castelnuovo MD, Davide Motta MD, DR Laura Albini, Daniele Distefano MD for the contribution in data collection. We also thank all the colleagues working at the Departments of Infectious Diseases and Radiology of the University of Brescia for providing assistance to patients, whose data served for the conduction of this study, and the patients themselves.
Conflict of interest
CT, EF and GC have received unrestricted educational grants (as speakers or for participation to conferences) from Abbott, Gilead, Merck, GlaxoSmithKline, Bristol Myers Squibb, Schering Plough and Roche Spa. The other authors report no relevant disclosures or associations with industry.
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