IMPACT OF CHRONIC HIV INFECTION ON BONE HEALTH AND EARLY OSTEOPOROSIS RISK AMONG YOUNG ADULTS RECEIVING ART
Keywords:
HIV; Antiretroviral Therapy; Bone Mineral Density; Osteoporosis Risk; Vitamin D; Body Mass Index; Pakistan.Abstract
Background: People living with human immunodeficiency virus (HIV) are increasingly vulnerable to skeletal complications despite improvements in survival associated with antiretroviral therapy (ART). Reduced bone mineral density (BMD) may develop during early adulthood due to treatment-related, nutritional, and inflammatory factors. This study assessed the prevalence of reduced BMD and its associated factors among young adults receiving ART in Lahore, Pakistan.
Study Type: Cross-sectional analytical study
Methodology: A hospital-based cross-sectional analytical study included 274 HIV-positive adults aged 18–40 years receiving ART for at least six months. BMD was assessed at the lumbar spine, total hip, and femoral neck using dual-energy X-ray absorptiometry (DXA). A Z-score ≤ −2.0 at any measured site indicated BMD below the expected range for age. ART duration, body mass index (BMI), vitamin D concentrations, C-reactive protein (CRP), and fracture history were evaluated. Multivariable logistic regression identified factors independently associated with reduced BMD.
Results: Reduced BMD was observed in 7.7% of participants (95% CI: 5.1%–11.4%). Its prevalence increased with ART duration, reaching 14.3% among participants treated for five years or longer. Longer ART duration was independently associated with increased odds of reduced BMD (aOR = 1.41 per year; 95% CI: 1.18–1.69; p < 0.001), whereas higher BMI was associated with lower odds (aOR = 0.73; 95% CI: 0.62–0.86; p < 0.001). Vitamin D deficiency affected 40.9% of participants but showed no significant association with reduced BMD. CRP levels and tenofovir exposure were also not significantly associated. Previous fractures were more frequent among participants with reduced BMD (19.0% versus 3.2%; p = 0.009).
Conclusion: Reduced BMD affects a proportion of young adults receiving ART in Lahore. Longer treatment duration and lower BMI were the principal independent correlates. Incorporating nutritional evaluation and targeted skeletal risk assessment into HIV care may support earlier identification of vulnerable patients.
