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.

背景：替诺福韦 (TDF) 对骨矿物质密度 (BMD) 有不利影响，而非酒精性脂肪性肝病 (NAFLD) 与较低的 BMD 相关。

目的：为了帮助了解 NAFLD 和 TDF 对 BMD 的相互影响，本研究旨在探讨 NAFLD 与接受长期 TDF 抗逆转录病毒治疗 (ART) 的 HIV 感染患者的 BMD 之间的潜在关联。

方法：共有 89 名接受基于 TDF 的 ART 治疗超过三年的 HIV 感染患者参加了这项横断面研究。我们使用超声波骨密度仪测量 BMD，并进行肝脏超声检查以确定脂肪肝的严重程度。NAFLD 与 BMD 的关联使用多元逻辑回归分析进行检查。

结果：NAFLD 患者的 BMD 状态比非 NAFLD 患者更差。感染艾滋病毒的 NAFLD 患者的骨质减少（42.86% 对 25.93%）和骨质疏松症（17.14% 对 3.70%）的发生率显着高于非 NAFLD 患者。多变量调整后，与非 NAFLD 患者相比，表现出更差 BMD 状态的 NAFLD 患者的优势比 (OR) 为 4.49（95% 置信区间 [CI] 1.42, 14.15）。

结论：根据我们的结果，在长期接受基于 TDF 的 ART 的 HIV 患者中，NAFLD 与较差的 BMD 状态显着相关，包括骨质减少和骨质疏松症。此外，我们可能希望避免在 HIV 感染的 NAFLD 患者中使用 TDF 进行 ART。