Usefulness of calcaneal quantitative ultrasound stiffness for the evaluation of bone health in HIV-1-infected subjects: comparison with dual X-ray absorptiometry

Figures & data

Table 1 Population characteristics

Parameter	Median (IQR)	N (%)
Age, years	52 (46–56)
BMI, kg/m^2	22.8 (20.9–25.4)
Time since HIV diagnosis, years	18 (11–23)
Prior cART exposure, years	15 (10–20)
Prior PI exposure, years	5 (0–9)
Prior TDF exposure, years	5 (3–7)
CD4+ T-cell nadir, cells/µL	168 (108–295)
Current CD4+ T-cells, cells/µL	622 (460–860)
Hgb, g/dL	14.3 (13.6–15.3)
Platelets ×1,000/µL	208 (172–245)
ALT, U/L	23 (16–33)
AST, U/L	22 (18–31)
HDL cholesterol, mg/dL	50 (40–62)
LDL cholesterol, mg/dL	115 (95–147)
Serum creatinine, mg/dL	0.8 (0.7–1.0)
e-GFR (CKD-EPI), mL/min/1.73 m^2	89.3 (76.9–103.5)
VACS index	16 (6–23)
Sex, male		107 (67.7)
HBV coinfection		6 (3.9)
HCV coinfection		39 (25.2)
Current cART:
PI-based		52 (32.9)
NNRTI-based		71 (44.9)
INI-based		35 (22.2)
NRTI in the regimen:
None		34 (21.9)
3TC only		3 (1.9)
TDF only		3 (1.9)
ABC+3TC		44 (28.4)
TDF+FTC		71 45.8)
HIV disease stage:
CDC-A		55 (36.2)
CDC-B		55 (36.2)
CDC-C		42 (27.6)
Lumbar mineralization status:
Normal		66 (53.7)
Osteopenia		44 (35.8)
Osteoporosis		13 (10.6)
Femoral mineralization status:
Normal		56 (45.2)
Osteopenia		57 (46.0)
Osteoporosis		11 (8.9)

Abbreviations: ABC, abacavir; BMI, body mass index; cART, combined antiretroviral therapy; CDC, Centers for Disease Control and Prevention; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; e-GFR, estimated glomerular filtration rate; FTC, emtricitabine; HBV, hepatitis B virus; HCV, hepatitis C virus; HDL, high-density lipoproteins; Hgb, hemoglobin; HIV, human immunodeficiency virus; INI, integrase inhibitor; IQR, interquartile range; LDL, low-density lipoprotein; NNRTI, nonnucleoside reverse-transcriptase inhibitor; NRTI, nucleos(t)ide reverse transcriptase inhibitor; PI, protease inhibitor; TDF, tenofovir difumarate; VACS, Veterans Aging Cohort Study; 3TC, lamivudine.

Table 2 Bone metabolism and mineralization indexes of enrolled patients

Parameter	Median (IQR)	N (%)
25-OH D2/D3 vitamin D, ng/mL	27.8 (15.3–38)
PTH, pg/mL	46.9 (31.9–58.2)
Serum phosphate, mg/dL	3.1 (2.8–3.4)
Calcaneal QUI/stiffness, %	78.1 (66.2–90.6)
Calcaneal T-score	−1.5 (−0.7−2.3)
Calcaneal BMD, g/cm^2	0.42 (0.34–0.50)
Lumbar spine BMD, g/cm^2	0.97 (0.87–1.12)
Femoral BMD, g/cm^2	0.84 (0.73–0.98)
FRAX score, %	2.9 (2.1–4.8)
25-OH D2/D3 vitamin D levels <30 ng/mL		73 (54.9)
25-OH D2/D3 vitamin D levels <10 ng/mL		14 (10.5)
PTH levels >65 pg/mL		18 (18.4)
Femoral osteoporosis or osteopenia		68 (54.9)
Femoral osteoporosis		11 (8.9)
Lumbar osteoporosis or osteopenia		57 (46.4)
Lumbar osteoporosis		13 (10.6)
Summary of clinical risk factors for
osteoporosis:
Menopausal status		25 (16.1)
Type 2 diabetes mellitus		20 (12.9)
Current or ex tobacco smoker		101 (65.2)
HBV or HCV coinfection		45 (29.0)
Hypogonadism		2 (1.3)

Abbreviations: BMD, bone mineral density; FRAX, Fracture Risk Assessment Tool; HBV, hepatitis B virus; HCV, hepatitis C virus; IQR, interquartile range; PTH, parathyroid hormone; QUI, quantitative ultrasound index.

Figure 1 Correlations between QUI/stiffness index and lumbar BMD (A), femoral BMD (B), FRAX score (C), and BMI (D).

Abbreviations: BMD, bone mineral density; BMI, body mass index; FRAX, Fracture Risk Assessment Tool; QUI, quantitative ultrasound index.

Table 3 Multivariate analysis of determinants of low calcaneal QUI/stiffness (<10° percentile)

Parameters	AOR	AOR 95% CI		P-value
		Lower	Upper
HCV coinfection	0.349	0.018	6.760	0.487
BMI (per unitary increase)	0.699	0.548	0.891	0.004
Duration of previous TDF exposure (per additional year)	0.945	0.644	1.388	0.773
Duration of previous PI exposure (per additional year)	1.226	0.965	1.557	0.095
Menopause	8.787	0.464	166.350	0.148
CDC-C stage	9.329	0.781	111.355	0.078
CD4+ T-cells/µL (per unitary increase)	1.004	1.001	1.007	0.016
Years from HIV-1 diagnosis (per unitary increase)	0.963	0.826	1.124	0.635
Serum 25-OH D2/D3 vitamin D levels <10 ng/mL	35.585	2.003	632.266	0.015
Diabetes	2.233	0.135	36.821	0.574
Currently on TDF-based regimens	1.457	0.155	13.702	0.742
Serum PTH levels (>65 pg/mL)	1.144	0.059	22.115	0.929

Notes: Bold values indicate statistical significance (P<0.05). Fitting of the model: Nagelkerke R square: 0.853; predictive accuracy: 93.8%; area under the curve (ROC): 0.903.

Abbreviations: AOR, adjusted odds ratio; BMI, body mass index; CDC, Centers for Disease Control and Prevention; CI, confidence interval; HCV, hepatitis C virus; HIV-1, human immunodeficiency virus type-1; PI, protease inhibitor; PTH, parathyroid hormone; QUI, quantitative ultrasound index; TDF, tenofovir difumarate.