Premature Skeletal Aging and Immunological Recovery in Romanian PLWH: A Cross-Sectional Analysis of Gender-Specific and Metabolic Risk Factors

As life expectancy for people living with human immunodeficiency virus (HIV) (PLWH) increases, long-term comorbidities, such as bone mineral density (BMD) loss, have emerged as significant clinical challenges. This study evaluated the prevalence and determinants of skeletal demineralization in a contemporary Romanian HIV cohort. A cross-sectional study was conducted among 180 PLWH (mean age 41.86 ± 12.69 years) undergoing stable antiretroviral therapy. Bone health was assessed via dual-energy X-ray absorptiometry (DXA), while body composition and metabolic status were evaluated using bioelectrical impedance analysis (BIA) and serum lipid profiling. A high prevalence of reduced skeletal mass (58.3%) was observed, with 10% of the cohort diagnosed with osteoporosis at a mean age of only 45.7 years. Significant correlations were identified between osteoporosis and a history of AIDS, active smoking, and hypertriglyceridemia. Notably, women with osteoporosis exhibited significantly lower current CD4+ T-cell counts (268.4 ± 180.5 cells/μL) compared to those with normal BMD. While the body mass index was an inconsistent predictor of bone health, BIA-derived bone mass effectively identified subclinical depletion. Our findings underscore a phenotype of premature skeletal aging in PLWH, driven by an interplay of immunological history, metabolic disturbances, and lifestyle factors. Early screening via DXA and BIA, alongside aggressive management of modifiable risks, is essential for mitigating fragility fractures in this aging population.