Avaliação da densidade e microarquitetura ósseas e composição corporal dos pacientes jovens com vírus da imunodeficiência humana

Abstract

Objective: To evaluate bone density and microarchitecture, in addition to body composition, in young patients with the human immunodeficiency virus (HIV) and compare with healthy control group, in order to understand the pathophysiological mechanisms involved and suggest early screening protocols. Methodology: We recruited 135 participants (81 infected and 54 healthy controls), of both genders, aged between 20 and 50 years. Participants were examined, questionnaires were applied, analysis of medical records, laboratory tests and 24-hour urine were completed. Dual X-ray absorptiometry (DXA) and peripheral quantitative high-resolution computed tomography (HR-pQCT) were performed to assess bone quantity and quality, respectively. Application of SARC-F quetionnaire, assessment of muscle strength with handgrip test, Test Up & Go (TUG) and body composition were performed to suspect or diagnose sarcopenia in these individuals. In order to screen morphometric vertebral fractures, vertebral fracture assessment (VFA) was performed using DXA. The tools FRAX and NOGG were applied to evaluate the risk porbability of fractures. Results: Fifty participants from each group completed the study. The median age was 40 (25–49) vs. 36.5 (22–50) for the HIV and control groups, respectively (p 0.120). Gender, race, weight, height, body mass index, and smoking were also statistically similar between groups. Bone mineral density [1.177 g/cm3 (0.971 – 1.446) versus 1.271 g/cm3 (0.947 – 1.627), p 0.023] and Z-score [-0.5 standard deviations (SD) (-2.1 – +2.4) versus +0.2 SD (-1.9 – +2.3), p 0.021] were statistically lower at lumbar spine of participants with HIV when compared to the control group. There were statistically lower bone parameters in the HRpQCT, mainly in the distal tibia of patients with HIV. Participants from HIV group presented higher risk of fractures, with statistical significance, calculated through FRAX tool. We found a 12% prevalence of morphometric vertebral fractures in asymptomatic individuals with HIV. Functional tests also showed statistically significant inferior results in the HIV subjects (TUG and SARC-F) and handgrip strength showed p 0.052 with lower values for the infected group. In terms of body composition, a greater number of participants in the HIV group showed changes in appendicular lean mass and appendicular lean mass adjusted for height when we used cutoff points suggested by well-established global protocols for the diagnosis of sarcopenia, although no significant differences were evidenced between groups. Conclusions: It is well established in literature that individuals with HIV develop pathophysiological mechanisms that reduce bone mass, alter body composition properties and present a higher risk of fractures, especially at older ages. In our study, we found lower bone and muscle parameters and the presence of fractures in a young population, which is not usually screened for the aforementioned complications. We have developed screening protocols for early diagnosis in order to reduce morbimortality and improve quality of life in young individuals at high-risk for fractures.