Study Shows Decrease in Bone Density is Dominant in People With HIV

Is there a bone loss associated with HIV in people who are living with the virus? The answer is yes as stressed by the recently concluded Chennai ART Symposium (CART 2011).

CART 2011 was organized in Chennai, India on 8th-9th of January 2011 by Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), in collaboration with Centre for AIDS Research (CFAR), Brown University, National Institute of Health (NIH), University of California (San Diego), Karolinska Institute, and HIV Medicine Association of India (HIVMAI).

“Decrease in bone density is seen in people living with HIV (PLHIV) when they initiate the antiretroviral therapy (ART)”, said Dr. Karen T Tashima, Associate Professor of Medicine, Alpert Medical School of Brown University.

Other factors that influence bone loss are liver disease, premature menopause, hypogonadism, smoking or tobacco use that decrease bone acquisition, said Dr. Tashima. It is important because PLHIV are at a heightened risk of liver associated illnesses particularly in communities where HIV is associated to injecting drug use (IDU) or a hepatitis B or hepatitis C (HCV) co-infection exists.

First reports of bone loss in PLHIV came from a study done on among male PLHIV taking protease inhibitors (Tebas, AIDS 2000) -which is a kind of drug used in ART regimen. HIV infection activates inflammatory cytokines leading to negative balance in bone metabolism, explained Dr. Tashima.

Citing studies that looked at bone loss among PLHIV, Dr. Tashima said that irrespective of ART regimen changes, there was bone loss reported in most of the studies. Greatest bone loss was in two arms that included tenofovir which is a powerful drug in ART regimen. However, there is no evidence that switching drugs in ART regimen improves bone mineral density (BMD).

Citing studies like Gilead 903, AF5142, AF224, STEAL and ASSERT, Dr. Tashima said that decrease in bone density was seen with initiation of ART and greater bone loss was reported among those PLHIV who were on ART regimen consisting of tenofovir.

She recommended that healthcare providers should stabilise bone loss during ART. She recommended bone screening for PLHIV particularly for all post-menopausal women and all men with age more than 50 years. (CNS)