A total of 17 cross-sectional studies compared ART-treated with non ART-treated patients and PI-treated with non PI-treated patients. Some studies evaluated ART and PI treatments. Ten cross-sectional studies (n=1,065) compared ART-treated and ART- untreated patients. Fourteen cross-sectional studies (n=1,201) compared PI-treated and PI-untreated patients.
ART-treated versus ART-naive patients.
In all but one study, the majority of the patients were male. In studies providing relevant data, ART groups had a higher average age and had known HIV infection for longer than ART-naive groups. In most studies the basal metabolic index was similar between groups. None of the studies adjusted for potential confounding factors. Reduced BMD was significantly more common in ART-treated patients than in ART-naive patients (OR 2.5, 95% CI: 1.8, 3.7; 10 studies). The odds of osteoporosis were significantly more common in ART-treated patients than in ART-naive patients (OR 2.4, 95% CI: 1.2, 4.8; 7 studies). No statistically significant heterogeneity was detected for either analysis (p=0.47 and p=0.73, respectively).
There was no evidence of publication bias for either outcome.
PT-treated versus PI-untreated patients.
Twelve studies provided data on the prevalence of osteoporosis, of which 11 provided information on previous exposure of the PI- untreated group to PI; of these 11 studies, 9 reported that PI- untreated patients were PI-naive and 3 reported that some of the PI-untreated patients were ART-naive. Four studies included only men, 2 included only women, and others were mixed but predominantly male. In 3 studies the gender ratio was not balanced in PI-treated and PI-untreated groups. Age and basal metabolic index were generally similar between patient groups.
Reduced BMD was significantly more common in PI-treated patients than in PI-untreated patients (OR 1.5, 95% CI: 1.1, 2.0; 14 studies).
The odds of osteoporosis were significantly greater in PI-treated patients than in PI-untreated patients (OR 1.6, 95% CI: 1.1, 2.3; 12 studies).
No statistically significant heterogeneity was detected for either analysis (p=0.25 and p=0.52, respectively).
Two studies adjusted for confounders and the authors adjusted the analysis for confounders for a third study. For these three studies, crude and adjusted analyses produced similar results.
The funnel plot of BMD showed some asymmetry but Begg's test was not statistically significant (p=0.16). There was no evidence of publication bias for studies included in the osteoporosis analysis.