Mineral and Bone Disorder in Patients Living with the Human Immunodeficiency Virus (HIV) on Hemodialysis: A Case Series

Abstract

Introduction: Survival of patients living with HIV has increased and low bone mineral density and fractures are reported in this population. Chronic kidney disease causes bone disorder, which also contributes to low bone mineral density, fractures, and vascular calcification. This study aimed to assess the osteometabolic profile in HIV patients undergoing hemodialysis. Methods: Data of 21 patients were assessed. Laboratory: calcium, phosphorus, albumin, intact parathyroid hormone, total alkaline phosphatase, 25OH-vitamin D, CD4 count and HIV viral load. Bone mineral density was assessed by bone densitometry, and x-rays were taken to determine vascular calcification scores. Results: The median age of patients was 48 years (81% male) and the median times of HIV infection and hemodialysis were 132 and 120 months, respectively. Median serum calcium and phosphorus levels were normal and the median intact parathyroid hormone was 360 pg/ mL. Osteopenia was diagnosed in 33% of patients and osteoporosis in 33%; 24% of patients had previously suffered fractures. The Kauppila score was higher in patients with fractures (p=0.040). Vascular calcification was identified in 12 (57%) patients. Inverse correlations were demonstrated between the Kauppila score and the T-score of the femoral neck (p<0.001) and the T-score of the lumbar spine (p<0.001); and between the Adragão score and T-score of the femoral neck (p=0.001) and the T-score of the lumbar spine (p=0.001). Conclusion: A high prevalence was observed of low bone mineral density, fractures and vascular calcification in HIV patients on hemodialysis. It is necessary to confirm these results with larger studies and with a control group of non-HIV patients.

Keywords

• hiv
• hemodialysis
• bone metabolism
• bone mineral density
• vascular calcification
• fracture