Bone health and HIV in resource-limited settings

Abstract

Purpose of reviewSub-Saharan Africa and other resource-limited settings (RLS) bear the greatest burden of the HIV epidemic globally. Advantageously, the expanding access to antiretroviral therapy (ART) has resulted in increased survival of HIV individuals in the last 2 decades. Data from resource rich settings provide evidence of increased risk of comorbid conditions such as osteoporosis and fragility fractures among HIV-infected populations. We provide the first review of published and presented data synthesizing the current state of knowledge on bone health and HIV in RLS.Recent findingsWith few exceptions, we found a high prevalence of low bone mineral density (BMD) and hypovitaminosis D among HIV-infected populations in both RLS and resource rich settings. Although most recognized risk factors for bone loss are similar across settings, in certain RLS there is a high prevalence of both non-HIV-specific risk factors and HIV-specific risk factors, including advanced HIV disease and widespread use of ART, including tenofovir disoproxil fumarate, a non-BMD sparing ART. Of great concern, we neither found published data on the effect of tenofovir disoproxil fumarate initiation on BMD, nor any data on incidence and prevalence of fractures among HIV-infected populations in RLS.SummaryTo date, the prevalence and squeal of metabolic bone diseases in RLS are poorly described. This review highlights important gaps in our knowledge about HIV-associated bone health comorbidities in RLS. This creates an urgent need for targeted research that can inform HIV care and management guidelines in RLS.Video abstract:http://links.lww.com/COHA/A9.

HIV-AIDS and Aging: Challenges and Management

“…Both HIV infection and ART treatment have been shown to be linked with the vitamin D deficiency and fragility of bones, though enough data to support this notion is lacking [30]. Similar observations have been reported to be prevalent in countries with resource-limited settings [31]. In addition, the data obtained from epidemiological studies have reflected that HIV/HCV co infected individuals display 3-fold enhanced fracture incidence in comparison to the uninfected persons.…”

Changes in Bone Mineral Density, Body Composition, Vitamin D Status, and Mineral Metabolism in Urban HIV-Positive South African Women Over 12 Months

“…The effects of HIV and ART on bone health and vitamin D status in Sub-Saharan Africa, where the burden of HIV infection lies, and where osteoporotic fracture rates are predicted to rise, (13) are largely unstudied, (14) and, although data are emerging, (15)(16)(17) there are important gaps and an urgent need for targeted research. (14) We have shown, in a cross-sectional study of urban South African premenopausal women which compared those who were HIV-infected but ART-naive with those who were HIV-negative, that there were no significant differences in aBMD or vitamin D status related to HIV status, despite HIV-positive women with low CD4 counts having less body fat than both HIV-positive women with preserved CD4 counts and HIV-negative women. (18) HIVpositive women in the low CD4 group were eligible to start ART under the South African medical guidelines current at the time of the study (2010).…”

“…Some of these studies are also limited by retrospective design and lack of an HIV‐negative control group. The effects of HIV and ART on bone health and vitamin D status in Sub‐Saharan Africa, where the burden of HIV infection lies, and where osteoporotic fracture rates are predicted to rise, are largely unstudied, and, although data are emerging, there are important gaps and an urgent need for targeted research …”

Reduced bone mineral density among HIV infected patients on anti-retroviral therapy in Blantyre, Malawi: Prevalence and associated factors

“…A decrease of about 2-6% in BMD in the first two years after initiation of ART regardless of the regimen has been reported [12]. Although reductions in BMD occur at initiation of ART irrespective of regimen, tenofovir-based regimens are associated with more bone loss than other regimens [10,[13][14][15]. Compared to other regimens, tenofovir leads to approximately 1-3% greater loss in BMD [10].…”