Influence of inflammatory markers in bone metabolism in patients with HIV infection treated or not with antiretroviral therapy

Author(s)

Erika Grasiela Marques de Menezes

• Document type: Doctoral Thesis
• Press: Araraquara. 2017-04-25.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Ciências Farmacêuticas. Araraquara
• Defense date: 2017-02-24
• Advisor: Anderson Marliere Navarro

Abstract

The natural history of HIV infection and antiretroviral treatment (ART) are well evidenced by increase in the CD4+ T cell count, reduction of viral replication, and reduced risk for opportunistic diseases. Despite the efficacy of ART, the current repercussions are the systemic effects of inflammation mediated by chronic HIV infection and toxicity of the antiretroviral drugs that significantly contribute to increase the risk of metabolic complications. We hypothesized that HIV-infected patients treated or not with antiretroviral therapy have increased levels of inflammatory markers that can affect bone metabolism leading to bone loss, and the patients with longer exposure to HIV and ART are more affected. Objective: Investigate the influence of pro-inflammatory cytokines in bone metabolism in patients with chronic HIV infection treated or not with antiretroviral therapy. Methods: A cross-sectional study was conducted on 50 HIV-seropositive men treated or not with ART. The participants were divided, according to the use or not of ART, into the control group (CG): 10 participants not in treatment; the G<2 years of ART group: 20 participants treated with ART for less than 2 years; and the G>2 years of ART group: 20 participants treated with ART for more than 2 years. Dual energy x-ray absorptiometry (DXA) was performed to evaluate bone mineral density and body composition. The dietary intake was evaluated. Blood was collected for measurement of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, total calcium, albumin. Urine samples were collected for measurement of 24h urinary calcium and urinary deoxypyridinoline. Statistical tests were performed to test for equality between groups, parametric tests and or nonparametric and correlation between quantitative variables, considering the significant differences p<0.05. Results: The participants not treated with ART exhibited higher values of IL-6 and TNF-α than the participants treated with ART for more than 2 years. TNF-α values were higher in the participants treated with ART for less than 2 years than in participants treated with ART for more than 2 years (p<0.05). The increased values of urinary deoxypyridinoline indicated a high reabsorptive activity of bone tissue in all groups, with a significant difference between the participants not treated with ART and the participants treated with ART for less than 2 years. Through the DXA we found a bone mass reduction in all bone sites in each group. Conclusion: The increased production of proinflammatory cytokines associated osteoclast activity affecting bone mass was most notably elevated in the viremic group. The reduction of bone mineral density was observed in all bone sites principally for the groups in treatment with antiretroviral therapy. (AU)

• FAPESP's process: 13/10765-4 - Influence of inflammatory markers of bone metabolism of HIV-seropositive patients in use or not antiretroviral therapy
• Grantee: Erika Grasiela Marques de Menezes
• Support Opportunities: Scholarships in Brazil - Doctorate