Bone and vitamin D metabolism in HIV

Abstract

Human immunodeficiency virus (HIV) infection has progressed to a chronic disease and HIV positive individuals are living longer lives. This has lead to an increase in morbidity and mortality due to secondary issues, one being HIV bone disease. HIV infected pediatric and adult populations have a greater incidence in reduction of BMD as compared to the controls. Osteoporosis has been reported to be present in up to 15 % of HIV positive patients. We are starting to understand the mechanism behind the changes in HIV bone disease. Viral proteins interfere with osteoblastic activity either by direct interaction or by the inflammatory process that they induce. Anti-viral management, including highly active antiretroviral therapy (HAART), protease inhibitors, and nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) also are involved in disrupting proper bone metabolism. Vitamin D levels have strong correlation with bone disease in HIV patients, and are dependent not only to chronic disease state, but interaction of pharmacologic management and inflammatory process as well. Work up of the secondary causes of osteopenia and osteoporosis should be undertaken in all patients. DEXA scan is recommended in all post-menopausal women with HIV, all HIV infected men 50 years of age or older and in those with a history of fragility fractures regardless of age or gender. Preventive measures include adequate nutrition, calcium and Vitamin D intake daily, muscle strengthening and balance exercises to increase BMD and reduce fractures. Bisphosphonates are considered to be the first line for the treatment of HIV associated bone disease. This review will describe how the balanced mechanism of bone metabolism is interrupted by the HIV infection itself, the complications that arise from HIV/AIDS, and its treatment options.

Dual-Energy X-Ray Absorptiometry And Calculated Frax Risk Scores May Underestimate Osteoporotic Fracture Risk In Vitamin D-Deficient Veterans With Hiv Infection

“…The pathophysiologic mechanisms of bone disease in HIV infection are complex and not fully understood. In addition to traditional risk factors, individuals with HIV are at increased risk for decreased BMD due to concomitant risk factors such as malnutrition, vitamin D deficiency, hypogonadism, antiretroviral therapies, chronic inflammation, and HIV infection itself (5,13–17). …”

Antiretroviral Therapy, Especially Efavirenz, Is Associated with Low Bone Mineral Density in HIV-Infected South Africans

“…Furthermore, the majority of people living with HIV in sub-Saharan Africa are young pre-menopausal women[ 9 ], who generally have a low risk of developing osteoporosis and who are under-represented in published studies. Vitamin D deficiency is a well-established secondary cause of osteoporosis in HIV-infected and HIV-uninfected people ([ 10 ]), and a recent South African study has shown that vitamin D deficiency is linked to poverty and is more common in the HIV-infected South African population[ 11 ].…”

Monthly or Weekly Supplementation with Cholecalciferol 20,000 IU in People Living with HIV: Results from a Nested Cohort Study

“…Interestingly, the use of neither efavirenz, nor TDF, nor any boosted PI regimen significantly influenced the response to vitamin D supplementation despite the potential interference with bone and vitamin D metabolism [ 17 , 23 – 26 ]. In the absence of HIV-specific factors that seem to influence the response to vitamin D supplementation, as suggested by the results of our data, general recommendations might also apply for PLWH.…”