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. 2025 Jul 15;110(8):2236-2242.
doi: 10.1210/clinem/dgae786.

Impaired Bone Tissue Quality Associated With Inflammation in HIV-immunological Nonresponders: A Cross-sectional Analysis

Oriol Rins-Lozano  1 , Jaime Rodríguez-Morera  2 , Itziar Arrieta-Aldea  2   3 , Alicia González-Mena  2 , Sergi Rodríguez-Mercader  2 , Lucía Suaya  2 , Mariano Pascual-Aranda  2 , Esperanza Cañas-Ruano  2 , María José Fernandez-Quiroga  2 , Cecilia Canepa  2 , Juan Du  2 , Agustín Marcos  2 , Hernando Knobel  2   4 , Natalia García-Giralt  2   5 , Robert Güerri-Fernández  1   2   4
Affiliations

Impaired Bone Tissue Quality Associated With Inflammation in HIV-immunological Nonresponders: A Cross-sectional Analysis

Oriol Rins-Lozano et al. J Clin Endocrinol Metab. .

Abstract

Introduction: People with HIV (PWH) with poor immune response despite adequate antiretroviral treatment (ART) are susceptible to non-AIDS-related health issues. This study seeks to evaluate bone quality in immunological nonresponders (INRs) in comparison to those with proper immune response (IRs) using in vivo microindentation to quantify bone quality, in addition to conventional bone mineral density (BMD) evaluations.

Methods: A cross-sectional study was conducted at Hospital del Mar in Barcelona from January 2019 to June 2023. Participants were matched in a 1:2 ratio (INRs:IR) based on age, sex, body mass index, and antiretroviral treatment. Participants underwent bone quality assessment using in vivo microindentation, BMD, and analysis of bone turnover and inflammation markers. Statistical analyses involved multivariable regression to adjust for potential confounding variables.

Results: A total of 159 PWH were included, 53 INRs and 106 IRs. INRs had worse bone quality, with lower median bone material strength index compared to IRs (79 [76-87] vs 86 [82-89]; P < .001), and similar BMD. INRs shown increased high-sensitive C-reactive protein levels with lower 25-(OH)-vitamin D3. A significant negative correlation between inflammation and bone quality was found, especially in INRs. Multivariable linear regression shown that INR status is a major predictor of decreased bone quality, regardless of conventional risk factors.

Conclusion: INRs' condition is significantly associated with higher inflammatory levels, which may contribute to a deleterious effect on bone quality as measured by in vivo microindentation. Further studies are needed to confirm these results and to focus on non-AIDS comorbidities in this subgroup of PWH.

Keywords: BMD; HIV; INR; bone quality; in vivo microindentation; inflammation; vitamin D.

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