Reduced bone mineral density in HIV-infected patients: prevalence and associated factors

Cazanave, Charles; Dupon, M.; Lavignolle-Aurillac, Valérie; Barthe, Nicole; Lawson-Ayayi, S.; Mehsen, Nadia; Mercié, P.; Morlat, P.; Thiébaut, Rodolphe; Dabis, François

doi:10.1097/qad.0b013e3282f423dd

Cited by 195 publications

(148 citation statements)

References 31 publications

Supporting

Mentioning

128

Contrasting

Unclassified

Order By: Relevance

“…A second meta-analysis investigated the effect of low bodyweight on BMD and concluded that the low bodyweight may largely account for the high prevalence of low BMD reported in HIV-infected patients [41]. A third study found that older age and low CD4 cell count nadir were independently associated with osteoporosis/osteopenia in women, but the use of ARVs were not related to osteoporosis after adjustment (p = 0.58) [40]. However, in another study of HIV-infected women, PI-containing ARV regimens and longer lopinavir use were associated with lower BMD [42].…”

Section: Generalmentioning

confidence: 99%

“…The few studies looking at the sex association to PI-related GI side effects found that women have higher frequencies of several symptoms compared with men [35][36][37]. Metabolic complications of ARV therapy include insulin resistance and glucose intolerance, dyslipidemia, changes in body fat distribution and, possibly, bone disorders [38][39][40][41][42][43]. Although PI therapies have been linked to glucose and lipid abnormalities [38], the mechanisms underlying other metabolic complications and their relationship to specific ARV therapies is not clearly delineated.…”

Section: Influence Of Sex On Arv-associated Adverse Events In Nonpregmentioning

confidence: 99%

“…With the exception of cervical disease, other conditions that can be screened for, including dyslipidemia, hypertension, osteoporosis, breast cancer and colon cancer, are associated with older age. In addition to age, conditions influenced by HIV infection (or induced immunosuppression) and possibly ARV therapy include hypertension [54][55][56] and bone diseases [40][41][42][43]. Dyslipidemia is another disorder more prevalent among older individuals and is a known complication of HIV infection and most PIs.…”

Section: Age-related Issues In Arv Managementmentioning

confidence: 99%

See 2 more Smart Citations

Considerations for the Antiretroviral Management of Women in 2008

Clark

2008

Womens Health (Lond Engl)

View full text Add to dashboard Cite

Clinicians should be familiar with sex-specific considerations when managing antiretroviral (ARV) treatment among women. Pregnancy is a critical influence on when to start treatment and what ARVs should be included in a regimen. Sex, pregnancy and hormonal contraceptive therapies can each influence ARV pharmacokinetic profiles. Women may be prone to have higher serum levels with selected ARV treatments, which may improve potency but also increase the risk for toxicities. Several studies have demonstrated that women do have higher frequencies of selected ARV-associated adverse events when compared with men. Although HIV treatment guidelines for nonpregnant women do not differ from men, clinicians should be aware of the high potential for certain ARV-related toxicities and follow suggestions in order to decrease the risk of side effects.The most recent statistics from the US CDC as of March 2008 show that the cumulative total number of women reported to have AIDS in the USA was 189,566 and women accounted for 26% of persons infected with HIV [101]. It has become increasingly clear that women have unique antiretroviral (ARV) management issues and clinicians should be familiar with sex-specific considerations. Women may metabolize selected drugs differently from men, which can result in different ARV pharmacokinetic profiles and the potential for adverse side effects. In addition, women of child-bearing potential have reproductive concerns that include optimal contraception and potential fetal toxicity for selected ARV therapies. When to start ARVsPregnancy status is the first consideration when determining whether to or when to initiate ARVs, since this will affect timing [102,103]. All pregnant women need to initiate ARVs regardless of their CD4 cell count or HIV RNA level. Those who have ARVs initiated only to prevent maternal-fetal transmission can afford to delay starting ARVs until after the first trimester, but others who require medication for their own health can start immediately, regardless of their gestational stage.The decision is more complicated for nonpregnant women. Over the years, the pendulum has swung both ways with regard to early versus late ARV initiation, with CD4 cell count criteria ranging from 500 down to 200 cells/mm 3 for asymptomatic HIV-infected nonpregnant individuals. Experts have carefully weighed possible survival benefits against long-term toxicities demonstrated in cohort studies and randomized clinical trials. The most recent version of the Department of Health and Human Services (DHHS) guidelines from January 2008 recommend initiating ARVs when the CD4 cell count drops to less than 350 cells/mm 3 for both men and nonpregnant women. The consideration for initiating ARVs for nonpregnant individuals with higher CD4 cell counts should take into account the specific patient scenario and comorbidities. Women with HIV-associated nephropathy or those who require treatment for a hepatitis B infection should have HIV treatment initiated, regardless of their CD4 cell count [102].In most c...

show abstract

Section: Generalmentioning

confidence: 99%

Section: Influence Of Sex On Arv-associated Adverse Events In Nonpregmentioning

confidence: 99%

Section: Age-related Issues In Arv Managementmentioning

confidence: 99%

See 1 more Smart Citation

Considerations for the Antiretroviral Management of Women in 2008

Clark

2008

Womens Health (Lond Engl)

View full text Add to dashboard Cite

show abstract

“…Along these same lines, Cazanave and cols. published that the prevalence of osteopenia in HIV-infected patients was 54.6% in men and 51.1% in women, whereas the prevalence of osteoporosis among this population was 33.7% in men and 8.3% in women (22). A systematic review of crosssectional studies by Brown and cols.…”

Section: Hiv and Low Bone Massmentioning

confidence: 99%

HIV infection, bone metabolism, and fractures

Güerri‐Fernández

Villar-García

Díez-Pérez

et al. 2014

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

With the advent of high active antiretroviral therapy there was a significant improvement on HIV subjects survival. Thus, bone changes related to HIV became an important aspect of these individuals. HIV affects bone remodeling causing bone fragility. In addition, antiretroviral therapy may also negatively affect bone metabolism. Several studies describe an increased incidence of fractures in these patients when compared with controls without the disease. The European Society of AIDS (EACS), and other societies, have included guidance on management of osteoporosis in HIV-infected patients emphasizing the identification of patients with low bone mass. Supplementation of calcium and vitamin D and the use of alendronate in these individuals should be recommended on a case base. RESUMOCom o advento da terapia antirretroviral, houve uma melhora considerável na sobrevida dos indivíduos portadores do vírus HIV. Dessa forma, as alterações ósseas referentes ao HIV se tornaram um fator importante no cuidado desses indivíduos. O HIV altera o remodelamento ósseo causando fragilidade óssea. As alterações causadas por esse vírus nos linfócitos T afetam a produção de RANKL e de citocinas pró-inflamatórias levando à osteoclastogênese. Ademais, a terapia antirretroviral também pode afetar negativamente o metabolismo ósseo. Vários estudos descrevem aumento da incidência de fraturas nesses indivíduos quando comparados a controles sem a doença. Diretrizes da Sociedade Europeia de SIDA (EACS) têm orientado o manejo da osteoporose nesses sujeitos, enfatizando a identificação de pacientes com baixa massa óssea. A suplementação de cálcio e vitamina D e o uso de alendronato nesses indiví-duos devem ser recomendados caso a caso. Arq Bras Endocrinol Metab. 2014;58(5):478-83 Descritores Osso; metabolismo ósseo; HIV; fraturas ósseas

show abstract

“…Therefore, EFV associated vitamin D deficiency may have potential adverse effects on bone health. [21][22][23][24] The growing number of HIV infected pregnant and lactating women on TDF/EFV containing regimens for PMTCT has the potential to have a negative impact on bone health of their infants and young children. Consequently, failure to achieve adequate bone mass during early infancy may predispose these infants to increased risk of childhood fractures and osteoporosis in adulthood.…”

mentioning

confidence: 99%