内科

目的对比人类免疫缺陷病毒（HIV）感染者/获得性免疫缺陷综合征（AIDS）患者抗逆转录病毒治疗（ART）启动前与健康人群的骨密度，并基于年龄与绝经状态进行亚组分析。方法采用回顾性病例对照研究，收集2021年7月至2023年6月柳州市人民医院99例ART启动前HIV感染者/AIDS患者（HIV/AIDS组）与99例健康体检者（健康对照组）的临床资料，采用双能X线吸收法检测腰椎骨密度（L1～L4 T值及总T值）；按年龄与绝经状态将两组划分为年轻亚组（绝经前女性及<50岁男性）和高龄亚组（绝经后女性及≥50岁男性），比较组间及亚组间骨密度。结果在总人群中，HIV/AIDS组L2 T值、L3 T值、L4 T值、总T值均低于健康对照组（均P<0.05），但两组L1 T值差异无统计学意义（P>0.05）。亚组分析结果显示：在绝经前女性及<50岁男性群体中，HIV/AIDS年轻亚组与健康对照年轻亚组L1 T值、L2 T值、L3 T值、L4 T值、总T值差异均无统计学意义（均P>0.05）；在绝经后女性及≥50岁男性群体中，HIV/AIDS高龄亚组L1 T值、L2 T值、L3 T值、L4 T值、总T值均低于健康对照高龄亚组，骨质疏松检出率高于健康对照高龄亚组，骨密度分级劣于健康对照高龄亚组（均P<0.05）。结论 ART启动前HIV感染者/AIDS患者已存在骨代谢异常，其中绝经后女性及≥50岁男性是骨密度降低与骨质疏松的高危人群；临床应在启动ART前即对HIV感染者/AIDS患者常规行骨密度检测，以指导ART方案优化与骨健康干预。

Objective To compare the bone mineral density between human immunodeficiency virus (HIV)-infected individuals/acquired immunodeficiency syndrome (AIDS) patients before antiretroviral therapy (ART) initiation and healthy people, and to conduct subgroup analyses based on age and menopausal status. Methods A retrospective case-control study was conducted. Clinical data of 99 HIV-infected individuals/AIDS patients (HIV/AIDS group) before ART initiation and 99 healthy physical examinees (healthy control group) were collected from Liuzhou People's Hospital between July 2021 and June 2023. Lumbar spine bone mineral density (L1-L4 T-scores and total T-score) was measured by dual-energy X-ray absorptiometry. Both groups were sub-divided into the young subgroup (premenopausal women and men aged <50 years) or the elderly subgroup (postmenopausal women and men aged ≥50 years). Bone mineral density was compared between groups and subgroups. Results In the overall population, the L2, L3, L4 T-scores, and total in the HIV/AIDS group were lower than those in the healthy control group (all P<0.05), while no statistically significant difference in L1 T-score was observed between the two groups (P>0.05). Subgroup analysis results showed that there was no statistically significant difference in L1, L2, L3, L4, or total T-score between the young HIV/AIDS subgroup and the young healthy control subgroup among premenopausal women and men aged <50 years (all P>0.05); among postmenopausal women and men aged ≥50 years, the elderly HIV/AIDS subgroup had lower L1, L2, L3, L4, and total T-scores, higher detection rate of osteoporosis, and worse bone mineral density grading than the elderly healthy control subgroup (all P<0.05). Conclusion Abnormal bone metabolism already exists in HIV-infected individuals/AIDS patients prior to ART initiation, among them, postmenopausal women and men aged ≥50 years are high-risk populations for decreased bone mineral density and osteoporosis. Therefore, routine bone mineral density detection should be performed clinically for HIV-infected individuals/AIDS patients even before ART initiation to guide the optimization of ART regimens and bone health intervention.

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