ORIGINAL ARTICLE 45 Int J HIV AIDS Res Vol 2 No 1 July 2019 1 Clinical Tutor, Armed Forces Medical College, Pune, India; 2 Professor & Head, Department of Medicine, Armed Forces Medical College, Pune, India; 3 Consultant Gastroenterologist, Sir Gangaram Hospital, New Delhi, India Correspondence: Dr Ghosh A, Clinical Tutor, Armed Forces Medical College, Pune, India. Telephone +9168219911, e-mail: afmc.arnab@gmail.com Received: July 14, 2019, Accepted: July 23, 2019, Published: July 30, 2019 OPEN ACCESS This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http:// creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com RESULTS The mean age of the study population was 37 years (37 ± 12.25, 20-59 years). Other baseline data are depicted in Table 1. A total of 89 (82.4%) patients had low vitamin D and among them 15 (16.85%) had osteoporosis and 32 (36%) had osteopenia. However, patients with normal vitamin D levels did not show low BMD. In this study we found that low BMD was significantly associated with increasing age, duration of HIV, low BMI, low serum albumin, calcium, vitamin D and low baseline CD4 levels. DISCUSSION The higher prevalence of low BMD and OP in People living with HIV/AIDS (PLHA) is a well-known fact. However, most of these prevalence studies are INTRODUCTION L ow bone mineral density (BMD) has been observed in HIV patients on antiretroviral therapy (ART) [1]. They have 4.3 times higher fracture rates [2,3] which further increase over years of follow-up. HIV patients on ART have 6.4-fold increased risk of osteopenia and 3.7-fold increased risk of osteoporosis compared to HIV-uninfected controls [4]. There is limited data on prevalence of osteopenia or osteoporosis in ART-naïve HIV positive patients. Our study was undertaken to estimate prevalence of low BMD in ART naïve HIV patients. METHODS This cross-sectional observational study was carried out at a tertiary care hospital in western Maharashtra, India between October 2014 and Oct 2016 in subjects above 18 years, being HIV positive for at least 03 years and not on ART or any calcium or vitamin D supplements. We excluded patients with pregnancy and other conditions predisposing to osteopenia (such as chronic kidney disease, prolonged glucocorticoid use, hyperthyroidism, malignancy, chronic obstructive airway diseases, immunosuppressant therapy, hypogonadism, anti-convulsant medication, hyperparathyroidism, prolonged immobilization, rheumatoid arthritis, and ankylosing spondylitis). Critically ill and bed-ridden patients were also excluded. A sample size of 100 was derived by reported prevalence of osteoporosis in HIV-infected cohorts as 15% [5]. We clinically assessed 108 patients and measured their serum albumin, calcium, phosphate, urea, creatinine, alkaline phosphatase (ALP), 25-hydroxy-vitamin-D, parathormone (iPTH), and urinary calcium-creatinine ratio, from a National accreditation board for testing and calibration of laboratories (NABL) and ISO 151819:2007 accredited laboratory. DXA scan of three sites viz. right forearm, right femur and lumbosacral (LS) spine was done by Hologic Discovery Model which utilizes one pass single-sweep scanning and a multi-element digital detector array paired with true fan-beam acquisition geometry, enabling rapid, dual-energy BMD measurements. The BMD was assessed in terms of WHO assigned T&Z scores. The BMD measured at femur and/or LS was taken into account for assessment of BMD. STATISTICAL ANALYSIS We used Chi-square test, Fishers’ exact test and multivariate analysis for analysis of data using IBM SPSS 2015 version 22.0.0. ETHICAL CONSIDERATIONS Written consent in Marathi/Hindi & English was taken from each patient and their identity was kept confidential. Each patient was identified by a serial number written on the protocol form. Approval from state and national level authority was taken. Bone health parameters in HIV positve patents not receiving antretroviral therapy - An observatonal cross-sectonal study in India Ghosh A 1 , Sashindran VK 2 , Puri P 3 Ghosh A, Sashindran VK, Puri P, et al. Bone health parameters in HIV positive patients not receiving antiretroviral therapy - An observational cross- sectional study in India. Int J HIV-AIDS Res 2019;2(1):45-50. Our primary aim was to assess point prevalence of osteoporosis/ osteopenia and overall BMD status based on dual energy X-ray absorptiometry (DXA) scan. Our secondary objectives were to correlate BMD with serum Vitamin D levels and to identify possible risk factors for osteoporosis and osteopenia in this population. Key Words: BMD; HIV; Menopausal; Parathormone; Osteopenia TABLE 1 Baseline parameters and variations in bone mineral density Parameters Mean ± SD (Range) Osteoporosis Number (%) Low BMD Number (%) P-value Age 37 ± 12.25 (20-59) 0.001 Below 40 years 43 (39.8) 0(0) 10 (15.38) Above 40 years 65 (60.18) 15 (34.8) 37 (86) Sex 0.078 Male No (%)-63 (58.33) 8 (12.6) 31 (49.2) Female No (%)-45 (41.67) 7(15.5) 16 (35.5) Menopausal status Post-menopausal No (%)-17(15.7) 7(41.1) 13(76.47) Others No (%)-91(84.3) 8 (8.7) 34 (37.36) BMI 21.5 ± 2.52(16.8- 28.1) 0.001 Low 9 (13.8) 7 (77.7) 8 (88.8) Normal 99 (91.66) 8(8.1) 39 (39.3) Base line CD4 578.06 ± 130.58 (380-790) 0.001 Above 500 cells/mcl 68 (62.96) 0 9 (13.2) Below 500 cells/mcl 40 (37.03) 15 (37.5) 38 (95) Duration of HIV (in years) 5.31 ± 1.71(3-8) 0.001 >5 52 (48.2) 15 (28.8) 39 (75) <5 56 (51.8) 0 8 (14.2) Sun light Exposure (in hours) 4.25 ± 1.46 (2-6) 0.001 >4 55 (50.92) 0 8 (14.5) <4 53 (49.07) 15 (28.3) 39 (73.5)