Osteoporosis International

, Volume 30, Issue 7, pp 1501–1510 | Cite as

CD4 T cell count is inversely associated with lumbar spine bone mass in HIV-infected men under the age of 50 years

  • M. K. Kwak
  • E. J. Lee
  • J. W. Park
  • S. Y. Park
  • B. -J. Kim
  • T. H. Kim
  • K. Suh
  • J. -M. Koh
  • S. H. LeeEmail author
  • D. -W. ByunEmail author
Original Article



HIV-infected men under the age of 50 years had a lower bone mass compared to that of HIV-uninfected men. Lower CD4 T cell counts, independent of whether antiretroviral therapy (ART) was used, were associated with lower BMD. HIV-infected patients with low CD4 T cell counts may need follow-up and intervention regarding bone health, including younger patients.


HIV-infected patients have a low bone mineral density (BMD) owing to multifactorial interaction between common osteoporosis risk factors and HIV-related factors, including chronic inflammation and ART. Although HIV infection and ART might affect bone metabolism, little data is available for patients aged under 50 years. We aimed to investigate the association of HIV infection-induced low CD4 T cell counts and ART with BMD in men aged under 50 years.


We performed an age- and body mass index–matched case–control study. BMD values of HIV-infected and HIV-uninfected men (< 50 years) were compared, and HIV-infected men were stratified by CD4 T cell counts and ART use.


After adjusting confounders, HIV-infected men with CD4 T cell counts ≥ 500 cells/μL (n = 28) and < 500 cells/μL (n = 139) had lower BMD at the femoral neck (FN, p < 0.001) and total hip (TH, p < 0.001) than HIV-uninfected men (n = 167). HIV-infected men with CD4 T cell counts < 500/μL had lower BMD at the lumbar spine (LS, p = 0.034) than those with counts of ≥ 500 cells/μL, but not at FN and TH. The CD4 T cell count (γ = 0.169, p = 0.031) was positively correlated with BMD at LS. There was no significant difference in the BMD (p = 0.499–> 0.999) between the ART-naïve (n = 75) and ART-user group (n = 92).


Despite their relatively younger age, HIV-infected men had a lower BMD than HIV-uninfected men. Lower CD4 T cell counts, irrespective of ART, might result in lower bone mass.


Bone mineral density CD4 T cell counts HIV infection 



We express our sincere gratitude to Suyeon Park, M.S. (Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea) for her valuable assistance with the statistical analysis.

Funding information

This study was supported by grants from the Asan Institute for Life Sciences, Seoul, Republic of Korea (Project Nos. 2016-568 and 2017-568).

Compliance with ethical standards

This study was approved by the Institutional Review Board (IRB) of Soonchunhyang University, Seoul Hospital (Seoul, Republic of Korea) (IRB no. 2017-03-014). The requirement for written informed consent from patients was waived due to the retrospective nature of the study and its impracticability.

Conflicts of interest


Supplementary material

198_2019_4942_MOESM1_ESM.pptx (47 kb)
Supplemental Fig. 1 A flowchart of patients in this study. (PPTX 46 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • M. K. Kwak
    • 1
    • 2
    • 3
  • E. J. Lee
    • 4
  • J. W. Park
    • 5
  • S. Y. Park
    • 4
  • B. -J. Kim
    • 1
  • T. H. Kim
    • 4
  • K. Suh
    • 2
  • J. -M. Koh
    • 1
  • S. H. Lee
    • 1
    Email author
  • D. -W. Byun
    • 2
    Email author
  1. 1.Division of Endocrinology and Metabolism, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University HospitalSoonchunhyang University College of MedicineSeoulSouth Korea
  3. 3.Division of Endocrinology and Metabolism, Department of Internal MedicineHallym University Dontan Sacred Heart HospitalHwaseong-SiSouth Korea
  4. 4.Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University HospitalSoonchunhyang University College of MedicineSeoulSouth Korea
  5. 5.Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan HospitalSoonchunhyang University College of MedicineCheonan-siSouth Korea

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