Background: Tenofovir (TDF) has a detrimental effect on bone mineral density (BMD),
while nonalcoholic fatty liver disease (NAFLD) is associated with a lower BMD.
Objective: To help understand the mutual effects of NAFLD and TDF on BMD, this study was designed
to explore the potential association between NAFLD and BMD in HIV-infected patients receiving
long-term TDF-based antiretroviral therapy (ART).
Methods: A total of 89 HIV-infected patients who received TDF-based ART for more than three
years were enrolled in this cross-sectional study. We measured BMD using an ultrasonic bone density
apparatus, and liver ultrasonography was performed to determine the severity of the fatty liver.
The association of NAFLD with BMD was examined using multiple logistic regression analyses.
Results: Patients with NAFLD showed a worse BMD status than those without NAFLD. The incidence
rates of osteopenia (42.86% versus 25.93%) and osteoporosis (17.14% versus 3.70%) were
significantly higher in HIV-infected patients with NAFLD than in those without NAFLD. After
multivariate adjustment, the odds ratio (OR) for patients with NAFLD exhibiting a worse BMD status
compared with those without NAFLD was 4.49 (95% confidence interval [CI] 1.42, 14.15).
Conclusion: Based on our results, NAFLD was significantly associated with a worse BMD status,
including osteopenia and osteoporosis, in HIV patients after receiving long-term TDF-based ART.
Furthermore, we may want to avoid using TDF for ART in HIV-infected patients with NAFLD.