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Bone & HIV CROI 2011
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from Jules: Here are several selected studies on bone at which collectively report: bone merabolism is negatively affected upon initiation of HAART which leads to bone loss, HCV coinfection increases fracture rates in HIV+vit D/calcium supplementation may offset loss but further study is needed to examine this, illegal drug use including heroin & methadone can cause bone loss as has been reported in previous studies, here at CROI one study found poppers & amphetamine use associated with bone loss, young men infected with HIV before 30 have not reached peak bone mass and already have low bone mineral density & thus are cumulatively negatively impacted by these several events. Here are ways in which HIV+ take multiple hits in bone loss and significantly help to explain why bone loss is so bad among HIV+ and why fracture risk is serious as people age, and bear in mind in the general population when a fracture occurs in the elderly mortality increases significantly and of note within the first few years after the fracture.
CROI: HAART-induced Immune Reconstitution: A Driving Force Behind Bone Resorption in HIV/AIDS (03/13/11)
We were surprised at our findings. A dramatic rise in bone resorption was immediately observed upon starting HAART. This began as early as 2 weeks, increased at 12 weeks and plateaued but remained elevated at 24 weeks. T cell reconstitution in immunocompromised mice mice led to similar reduction in bone mineral density as seen with HAART in HIV+ patients, this was also evident in significant bone structural abnormality in the bone of the T cell reconstituted mice. TAKEN TOGETHER, our data suggests that HAART-related bone loss begins much earlier than previously suspected and may be driven by a mechanism of T cell reconstitution and osteoclastogenic cytokine production as a consequence of HIV-disease reversal. IMPORTANTLY, our data identifies an explorable window for pre-emptive intervention to block skeletal decline following HAART.
CROI: Vitamin D Supplements May Limit Tenofovir Bone Toxicity - written by Mark Mascolini - (03/20/11)
vitamin D3 supplementation appeared to offset a negative impact of tenofovir on parathyroid hormone (PTH), which enhances release of calcium from bone
CROI: Changes in bone biomarkers in antiretroviral naïve HIV-infected men randomised to nevirapine/lopinavir/ritonavir (NVP/LPV/r) or zidovudine/lamivudine/lopinavir/ritonavir (AZT/3TC/LPV/r) help explain limited loss of bone mineral density over first 12 months after antiretroviral therapy (ART) initiation (03/14/11)
CROI: Firstline HAART Causes Bone Loss (03/14/11)
"we demonstrated a rapid BMD decrease in both femoral neck and lumbar spine after initiation of cART, in parallel to an increase in bone turnover. ........lactic acidemia due to NRTI-related mitochondrial dysfunction has also been suggested to play a role in reduced (total body) BMD in HIV-infected patients."
CROI: LOW BONE MASS IN BEHAVIORALLY HIV-INFECTED YOUNG MEN ON ANTIRETROVIRAL THERAPY: Adolescent Trials Network (ATN) Protocol 021B (03/13/11)
HIV-positive young men on antiretroviral therapy with a relatively short period since HIV+ diagnosis have evidence of lower bone mass, when compared to seronegative controls of similar age and racial/ethnic distribution.
CROI: Bone Loss in HIV-Negatives in PrEP Study: 'a surprising percent of HIV-neg MSM had low bone mineral density before starting TDF, drug use associated with bone mineral density loss - vitamin D/calcium supplementation was protective'; in some HIV+ persons low BMD likely predated HIV-infection....in summary Kathy Mulligan said "it is not known whether there will be any long-term clinically important effects of PrEP with TDF/3TC (Truvada) on bone health" - (03/23/11)
Popper use & amphetamine use was associated with low BMD at baseline in TDF PrEP study, use of calcium & vitamin D supplements were protective against having low BMD
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