Prognostic Value of Serum Estrogen, Cortisol, Calcium and Alkaline Phosphatase Activity in Pre and Postmenopausal HIV Women at Nnewi, Nigeria

Background: Incidence of HIV infection is increasing fastest in women, and older age and some hormonal-deficient status may place them at higher risk for bone loss and fracture. The etiology of bone mineral loss in human immunodeficiency virus (HIV) infected patients is likely multifactorial, involving traditional risk factors such as low body weight, hypogonadism, as well as direct effects of chronic HIV infection and antiretroviral therapy.

Aims of Study: This study was designed to assess the prognostic value of Serum estrogen, cortisol, FSH, PTH, 25) OH Vit D, calcium and alkaline Phosphatase activity in pre and postmenopausal HIV infected women at NAUTH Nnewi, Nigeria.

Material and Methods: This was a cross-sectional study carried out from 2013 to 2014. A total of 80 female participants within the age bracket of 19-45(premenopausal) and 46-80 years (postmenopausal) were randomly recruited for the study. They were grouped into: (i) HIV-infected postmenopausal females (n=20). (ii) HIV- infected premenopausal females (n=20). (iii) Control postmenopausal females (n=20). (iv) Control premenopausal females (n=20). Blood samples were collected for determination of estrogen, FSH, PTH, 25OH Vitamin D and cortisol using Enzyme linked Immunosorbent Assay (ELISA) techniques. Serum levels of calcium and alkaline phosphatase activity were analyzed using spectrophotometric methods and CD4+ T-cell count using cyflow counter.

Results: The result showed that the mean serum alkaline phosphatase and cortisol levels were significantly higher while PTH and CD4+T-cell count were significantly lower in premenopausal HIV females when compared with the corresponding values in premenopausal control females (P=.05). The mean serum calcium, PTH, 25OH Vit D and CD4+ T- cell count were significantly lower while cortisol was significantly higher in postmenopausal HIV infected females compared to postmenopausal Control counterparts (P=.05). Serum estrogen and 25OH Vit D levels and CD4+ T-cell count were significantly higher while the mean serum calcium, FSH and PTH were significantly lower in premenopausal HIV when compared with postmenopausal HIV infected females (P=.05).

Conclusions: The present study shows alterations in both hormonal and biochemical indices of bone minerals in HIV infected women. This demonstrates significant derangement in bone health of pre and post-menopausal HIV-infected female subjects thereby increasing the risk of pathological bone fractures and can result in possible development of osteoporosis as the HIV infection progresses in these women. The clinical implication is discussed.