Multivariable Analysis of Bone Mass Reduction Risk Prediction and Anxiety Status in Male HIV/AIDS Patients

Keke Hou¹Tao Li¹Shuyin Zhang¹Jianglin He¹Ting Wan¹Yueqin Gao¹Lei Xiong¹Siqi Fu¹Na Zhang¹Guocheng Zhao^2*

• ¹Public Health Clinical Center of Chengdu, Chengdu, China
• ²The Fourth People's Hospital of Chengdu, Chengdu, China

Background: Psychological disorders and bone mass reduction are common among patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). This study evaluated anxiety status in male HIV/AIDS patients, developed a risk prediction model for bone mass reduction, identified major risk factors, and assessed model performance. Methods: This cross-sectional study enrolled 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, while anxiety information was prospectively assessed during hospitalization using the 14-item Hamilton Anxiety Rating Scale (HAM-A). Univariate and multivariate logistic regression analyses were used to identify independent predictors of bone mass reduction, and a nomogram model was built and validated using the area under the curve (AUC), concordance index (C-index), Hosmer–Lemeshow test, and decision curve analysis (DCA). Results: According to HAM-A, 55.6% of patients had mild anxiety, 30.0% moderate, 11.9% marked, and 2.5% severe. 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). Multivariate analysis confirmed these as independent predictors. The model achieved an AUC of 0.835 (95% CI 0.775–0.894) and a bootstrap-validated C-index of 0.835, with good calibration (P = 0.483) and clinical utility. Conclusion: Bone mass reduction in male HIV/AIDS patients is strongly linked to age, BMI, ART/TDF exposure, and viral markers. Anxiety was prevalent but not independently related to bone loss. The nomogram model showed excellent discrimination and calibration, providing a reliable tool for early detection and preventive management in clinical practice.