Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review

Brown, Todd T.; Qaqish, Roula B.

doi:10.1097/qad.0b013e32801022eb

Cited by 808 publications

(689 citation statements)

References 44 publications

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“…[23][24][25] In a recent meta-analysis, 15% of HIV-infected patients had osteoporosis, for a pooled odds ratio of 3.7 compared to HIV-negative controls. 26 In a separate study, vitamin D insufficiency (81%) and secondary hyperparathyroidism (26%) were other frequent findings among HIV patients treated with HAART for more than 5 years. 25 Osteoporosis, hyperparathyroidism, elevated calcium phosphate product, chronic renal failure, and diabetes mellitus have all been associated with medial as well as intimal calcification.…”

Section: Discussionmentioning

confidence: 89%

Calcification of the internal elastic lamina of coronary arteries

et al. 2008

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Two well-recognized patterns of calcification occur in large-and medium-sized arteries, intimal calcification associated with atherosclerosis and medial calcification described by Mö nckeberg. Calcification limited to the internal elastic lamina is a third pattern of calcification not previously reported in coronary arteries. Here we describe 19 cases of coronary artery internal elastic lamina calcification. We serially sectioned and examined the coronary arteries of 66 patients with advanced AIDS and 27 HIVÀ controls with other chronic illnesses. We observed calcification of the internal elastic lamina in 10 HIV þ patients and 9 controls. HIVÀ patients with internal elastic lamina calcification were significantly older than HIVÀ patients without it (P ¼ 0.008) and HIV þ patients with it (P ¼ 0.006). Occasionally, calcification encroached on adjacent intimal or medial tissue with mild fibrosis. There was frequent disruption of the internal elastic lamina but no evidence of inflammation. Calcification was the dominant histologic feature in all cases. Von Kossa, Alizarin red, and trichrome/elastic stains confirmed these findings. Patients with internal elastic lamina calcification often had extensive medical histories but did not suffer from chronic renal failure or other conditions known to cause calcium dysregulation. We describe coronary internal elastic lamina calcification in HIV þ patients and older HIVÀ adults. The clinical significance of this finding is unknown. It could lead to arterial stiffening and increased pulse pressure and could be mistaken for intimal calcification on coronary imaging. Internal elastic lamina calcification may result from premature aging due to HIV disease and chronic illness or from metabolic disorders in HIV þ patients.

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Section: Discussionmentioning

confidence: 89%

Calcification of the internal elastic lamina of coronary arteries

et al. 2008

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“…Kondisi tersebut dilaporkan meningkatkan risiko osteopenia 6,4 kali serta osteoporosis 3,7 kali. 35 Penurunan kepadatan tulang ini bersifat progresif dan tidak dipengaruhi oleh pemberian terapi ARV. Faktor-faktor yang mempengaruhi hal ini adalah meningkatnya usia, merokok, indeks massa tubuh yang rendah, malnutrisi, hipogonadisme, infeksi hepatitis, konsumsi alkohol berlebih dan penggunaan opiat.…”

Section: Jatuh Dan Kesehatan Tulangunclassified

HIV pada Geriatri HIV in Geriatrics

Ainun¹,

Yunihastuti²,

Roosheroe³

2017

JPDI

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ABSTRAKJumlah pasien HIV yang berusia lanjut semakin bertambah dikarenakan angka kesintasan pasien yang meningkat dan infeksi HIV pada pasien usia lanjut. Populasi pasien tersebut membutuhkan penatalaksaan tersendiri dikarenakan terdapat sejumlah komorbid baik yang berhubungan dengan HIV maupun tidak, polifarmasi, penurunan kapasitas fungsional dan isu sosial. PENDAHULUANJumlah pasien HIV berusia tua meningkat dari tahun ke tahun. Hal ini selain disebabkan oleh angka kejadian yang meningkat, juga disebabkan oleh terapi antiretroviral yang efektif sehingga angka harapan hidup bertambah. Sejak highly active anti-retroviral therapy (HAART) diperkenalkan pada tahun 1996 dan dimulai terapi anti retroviral kombinasi, pasien HIV yang terdiagnosis awal dan mendapat terapi antiretroviral dapat hidup seperti orang normal pada umumnya. 1 Pada penelitian yang dilakukan oleh Greene, dkk. 2 ditemukan rentang waktu terpanjang dari pasien terdiagnosis HIV hingga saat penelitian dilakukan mencapai 21 tahun. 2 Terapi antiretroviral menurunkan efek HIV dan peradangan kronik, namun tidak halnya dengan fungsi imunologis normal. Angka kesintasan pada pasien HIVusia lanjut yang mendapat terapi antiretroviral 30% lebih rendah dibanding populasi muda. Selain itu, kematian lebih cepat terjadi dalam empat tahun pertama semenjak terapi antiretroviral dimulai. 3 Belum diketahui pasti penyebabnya, namun diperkirakan perhatian yang kurang terhadap kepatuhan berobat, interaksi obat dan toksisitas, serta komorbid multipel memiliki pengaruh. Dengan demikian, dibutuhkan pendekatan tersendiri dalam menangani pasien HIVusia lanjut.

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“…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%

Considerations for the Antiretroviral Management of Women in 2008

Clark

2008

Womens Health (Lond Engl)

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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...

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Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review

Cited by 808 publications

References 44 publications

Calcification of the internal elastic lamina of coronary arteries

Calcification of the internal elastic lamina of coronary arteries

HIV pada Geriatri HIV in Geriatrics

Considerations for the Antiretroviral Management of Women in 2008

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