HIV-1 infection and antiretroviral therapies: risk factors for osteoporosis and bone fracture

Abstract

Purpose of review Patients with HIV-1 infection/AIDS are living longer due to the success of highly active antiretroviral therapy (HAART). However, serious metabolic complications including bone loss and fractures are becoming common. Understanding the root causes of bone loss and its potential implications for aging AIDS patients will be critical to the design of effective interventions to stem a tidal wave of fractures in a population chronically exposed to HAART. Recent findings Paradoxically, bone loss may occur not only due to HIV/AIDS but also as a consequence of HAART. The cause and mechanisms driving these distinct forms of bone loss, however, are complex and controversial. This review examines our current understanding of the underlying causes of HIV-1 and HAART-associated bone loss, and recent findings pertaining to the relevance of the immuno-skeletal interface in this process. Summary It is projected that by 2015 more than half of the HIV/AIDS population in the USA will be over the age of 50 and the synergy between HIV and/or HAART-related bone loss with age-associated bone loss could lead to a significant health threat. Aggressive antiresorptive therapy may be warranted in high-risk patients.

An increased risk of osteoporosis in a HIV-infected patient in the era of HAART. Case report analysis

“…Optimal treatment protocols need to be defined better in an ageing and growing HIV-positive population and therapeutic strategies promptly implemented. Aggressive antiresorptive therapy may be warranted in high-risk patients especially over 50 years of age and older [47]. The safety and cost-effectiveness of these and other treatments needs to be evaluated.…”

Association of Blood Biomarkers of Bone Turnover in HIV-1 Infected Individuals Receiving Anti-Retroviral Therapy (ART)

“…The prevalence of low bone mineral density (BMD) is higher in HIV-1 infected individuals and worsens in men on ART [11]. Risk of osteoporosis is becoming relevant to daily clinical practice in HIV-1 infected aging persons especially for those receiving ART [22].…”

HIV and ageing: what the geriatrician needs to know

“…80 Multiple factors contribute to this BMD loss including the presence of traditional risk factors such as increased age, smoking, low body mass index, 81 undernutrition, excess alcohol intake and use of illicit drugs, especially opiates, 78 as well as hypogonadism and hepatitis co-infections. 80 These work alongside HIV-specific factors such as chronic inflammation and cytokine induction, 82 malabsorption of calcium and changes in body composition. 77 Lastly cART may have a deleterious effect on BMD, particularly on initiation, though the clinical significance remains unproven.…”