Multivariable analysis of bone mass reduction risk prediction and anxiety status in male HIV/AIDS patients

The psychological health issues and bone mass reduction observed in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) have attracted increasing public attention. This study aimed to assess anxiety status in male HIV/AIDS patients, develop a risk prediction model for bone mass reduction, identify major contributing factors, and evaluate the predictive performance of the model.

This cross-sectional study included 243 male HIV/AIDS inpatients who underwent dual-energy x-ray absorptiometry (DXA) at the Chengdu Public Health Clinical Medical Center, China, between March 2023 and December 2024. Clinical and laboratory data were retrospectively extracted from the hospital electronic medical record system, whereas anxiety information was prospectively assessed during hospitalization using the 14-item Hamilton Anxiety Rating Scale (HAM-A). Univariate and multivariate logistic regression analyses were performed to identify independent predictors of bone mass reduction, and a nomogram model was constructed and validated using the area under the curve (AUC), concordance index (C-index), Hosmer-Lemeshow test, and decision curve analysis (DCA).

1. HAM-A assessment of the 243 patients showed that 135 (55.56%) were likely to have anxiety, 73 (30.04%) were confirmed to have anxiety, 29 (11.93%) had marked anxiety, and 6 (2.47%) were likely to have severe anxiety. 2. Univariate analysis revealed that six variables-age, body mass index (BMI), antiretroviral therapy (ART), tenofovir disoproxil fumarate (TDF) exposure, hepatitis B surface antigen (HBsAg) positivity, and hepatitis C virus antibody (Anti-HCV) positivity-were significantly associated with bone mass reduction (P < 0.05). 3. Multivariate logistic regression analysis further confirmed these six variables as independent risk factors for bone mass reduction (P < 0.05). The AUC was 0.835 (95% CI: 0.775-0.894, P < 0.01), indicating good predictive performance. The bootstrap-validated C-index was 0.835, and the Hosmer-Lemeshow test (P = 0.483) demonstrated good calibration of the model. DCA showed that the model achieved favorable accuracy and net benefit across a wide range of threshold probabilities (0.04-0.90).

Bone mass reduction in male HIV/AIDS patients is closely associated with multiple clinical factors, particularly the duration of ART and TDF exposure, age, BMI, and viral markers. In addition, the high prevalence of anxiety symptoms among these patients warrants clinical attention. The developed risk prediction model for bone mass reduction demonstrated good discrimination and calibration, providing an effective tool for clinical practice to identify high-risk patients and facilitate early intervention.