Impact of HIV-1 Infection and Antiretroviral Therapy on Bone Homeostasis and Mineral Density in Vertically Infected Patients

Abstract

Daily assumption of antiretroviral drugs and HIV-related immune activation lead to important side effects, which are particularly evident in vertically infected patients. Bone homeostasis impairment and reduction of bone mineral density (BMD) is one of the most important side effects. Primary aim of this study is to assess the prevalence of bone homeostasis alterations in a group of vertically infected patients; secondary aim is to analyze the relationship between bone homeostasis alterations and anthropometric data, severity of HIV infection, and antiretroviral therapy. We studied 67 patients with vertically transmitted HIV-1 (aged 6-31 years), followed by the Pediatric Infectious Disease Unit of the University Hospital of Padua, Italy. We analyzed bone turnover markers (P1NP and CTx) and we performed lumbar spine and femoral dual energy X-ray absorption densitometry (DXA). Personal and anthropometric data and information on HIV-infection severity and antiretroviral therapy were collected for all patients. We found that BMD values recorded by DXA showed a significant correlation with age, race, BMI, physical activity, and antiretroviral therapy duration. P1NP was increased in 43% of patients, while CTX in 61% of them. P1NP alteration was related to age, race, BMI, physical activity, therapy duration, and ever use of protease inhibitors and nucleotide reverse transcriptase inhibitors. CTX alteration was found to be correlated only with age. In conclusion, our study confirms that a wide percentage of HIV vertically infected patients show reduced BMD and impaired bone homeostasis. Strict monitoring is needed in order to early identify and treat these conditions.

Height adjustment reduces occurrence of low bone mineral density in children and adolescents with HIV

“…PI was used with most participants, which limited the analysis of its effect on BM. BMD showed a negative correlation with age, as observed recently 20,22 . Pubertal delay and disease chronicity justify this association.…”

“…This variability is related to the profiles involved, especially age and clinical category. Studies with older participants 2,22 or those with a predominance of category C 2,9 showed higher rates of impaired BM. When greater age and a predominance of category C are associated, the occurrence of low BM reaches 32% 2 .…”

“…Approximately one-fourth of the patients had reduced BMD in the lumbar spine and 5.8% had low BM. The occurrences were 21, 34, and 42% 9,21,22 for reduced BMD and 4, 11, 15%, 16%, and 32% for low BMD 2,3,9,21,23 have been reported. This variability is related to the profiles involved, especially age and clinical category.…”

“…Participants with reduced BMD were thinner and older, a difference that was maintained after adjustment for height. Low weight, more prevalent in children and adolescents with vertical HIV, is associated with lower BMD and related to disease chronicity [20][21][22] . The compromised nutritional status and the chronicity of the disease seem to negatively impact the acquisition of BM in children and adolescents with vertical HIV.…”

Synthesis and Characterization of Long-Acting Darunavir Prodrugs

“…While antiretroviral therapy (ART) has revolutionized human immunodeficiency virus type one (HIV-1) infection, treatment and preventative drug regimens require strict adherence to daily dosing. With substantive extensions in longevity and quality of life, ART still remains associated with a number of adverse drug reactions, poor regimen compliance and drug resistance (1)(2)(3). Comorbid events include stigma of infection, depression and neuropsychiatric disorders associated with or without substance abuse.…”