Bone mineral density changes after 2 years of ARV treatment, compared to naive HIV-1-infected patients not on HAART

Abstract

Osteoporosis and osteopenia are frequent in HIV-infected males. After ARV initiation, BMD decreased, and bone turnover markers increased, even though the BMD remained stable in non-treated patients. These results underline the impact of HIV treatment on BMD and bone metabolism.

The protease inhibitors and HIV-associated bone loss

“…However, many will experience age-related comorbidities including musculoskeletal abnormalities, cardiovascular diseases, renal impairment, and certain non-AIDS associated malignancies with greater frequency and at younger ages than their HIV-uninfected counterparts [5, 6*, 7*]. Indeed, HIV infection is now an established risk factor for osteopenia and osteoporosis [8] as defined by the World Health Organization criteria [femoral neck or lumbar spine T-score as measured by dual energy X-ray absorptiometry (DXA) between −1.0 and −2.5 (osteopenia) and less than or equal to −2.5 (osteoporosis)] [9].…”

“…Indeed, HIV infection is now an established risk factor for osteopenia and osteoporosis [8] as defined by the World Health Organization criteria [femoral neck or lumbar spine T-score as measured by dual energy X-ray absorptiometry (DXA) between −1.0 and −2.5 (osteopenia) and less than or equal to −2.5 (osteoporosis)] [9]. cART further aggravates rather than alleviates HIV-associated bone loss by inducing an additional 2% to 6% loss in bone mineral density (BMD) within the first two years of therapy, a rate of bone loss comparable to that seen in post-menopausal osteoporosis, the archetype of fragility bone disease [7*, 9, 10]. The rate of BMD loss decreases after 1–2 years of cART [11–13], but whether bone resorption returns to baseline (already elevated in HIV-infected subjects) or to levels associated with uninfected subjects remains unclear.…”

Bone Loss in HIV Infection

“…In a meta-analysis by Brown and Qaqish, HIV-infected individuals on cART had a 2.5-fold increased odds of prevalent low BMD compared with those who were cART-naïve [47]. This effect is universal across all antiretroviral drug classes, although the magnitude of BMD loss may vary by drug regimen [5, 48–50]. Of particular interest is the observation that the vast majority of bone loss occurs within the first 1–2 years after cART initiation, with subsequent stabilization of BMD thereafter [51–53].…”

“…Osteopenia and osteoporosis as defined by the World Health Organization criteria [femoral neck or lumbar spine T-score as measured by dual energy X-ray absorptiometry (DXA) between −1.0 and −2.5 (osteopenia) and less than or equal to −2.5 (osteoporosis)] [4] are associated with HIV infection itself, as well as with cART [5, 6]. Indeed, cART further aggravates the bone mineral density (BMD) loss associated with HIV infection: patients experience an additional 2% to 6% BMD loss in the first 1–2 years of cART, a rate of bone loss similar to that seen in postmenopausal osteoporosis [7, 8].…”

Manifestations ostéoarticulaires associées à l’infection par le VIH

“…Ainsi, chez les patients naïfs d'antirétroviraux, la prévalence de l'ostéopénie était évaluée entre 20 et 65 % et celle de l'ostéoporose entre 0 et 14 %, contre respectivement 22 à 76 % et 3 à 30 % pour les patients traités par antirétroviraux. D'où le sentiment que les trithérapies antirétrovirales étaient probablement impliquées dans le mécanisme de l'ostéoporose [3]. En 2006, Brown et al [4] ont réalisé une méta-analyse des 20 études publiées sur la perte osseuse chez le patient infecté par le VIH.…”