Bone Disease Is Increased in HIV; Cancer Risk Increases with Age & Immune Deficiency
Aging appears to affect immune system and increases frailty and encourages organ dysfunction. HIV and aging affect development of malignancies and non-AIDS comorbidities. Jules Levin
Bill Powderly raised the point in this talk at CROI that the missing answer is what is the clinical outcome, that is will earlier onset of bone disease in HIV positives translate into a higher fracture rate. I maintain that we can't wait to get this iformation before acting to prevent this occurrence because by the time we get that data it wil be too late. This is similar to the argument regarding heart disease and HIV from several years ago where the question was will higher lipid levels translate into greater rates of heart disease. W didn't wait for answers before incorporating prevention into care. And I say we need to incorporate prevention into care now regarding bone disease while we also institute a research initiative to get the answers.
HIV-Positives are more likely to have osteopenia and osteoporosis in this study (SUN Study) presented at CROI 2007 by Turner Overton, Washington University.
Powderly said sorting out an effect of HIV or treatment effect on bone disease will not be easy because there are so many risk factors.
Another potential confounding effect is that peak bone mass occurs at a certain age of about 30 yrs and so if a person contracts HIV prior to peaking this could effect the rate of decline in bone mineral density over the following years. We have very little data on the rate of decline in BMD in HIV+ individuals.
Why Is This A Problem??
Because of the "risk for significant morbidity when has true osteoporosis with progressive bone loss...This is a particularly critical research area because we need longitudinal studies to see if the bone loss over time is greater in HIV due to the higher rates of bone loss in HIV at younger ages compared to the general population and will this lead to higher fracture rates that will be seen at an earlier time point or even at an expected time point that could be avoided.
Age and immune deficiency (CD4 count) are critical issues related to the development of cancers. Cancer rates increase with age as evidenced in the CDC slide above. In addition to the DAD Study reporting an association of lower latest CD4 count with malignancy & and a fatal outcome another study at CROI 2008 reported finding viral load and CD4 count was associated with the development of cancers.
