Bone Loss in Nearly Half of HIV-Positive Patients on Antiretroviral Therapy

September 22, 2010 (Boston, Massachusetts) — Clinically relevant bone loss occurs in up to one third of patients with HIV infection, according to a longitudinal study presented here at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). In addition to traditional risk factors for bone loss (age, sex, and low body mass index), HIV-specific factors such as antiretroviral therapy were significantly related to the development of osteopenia and osteoporosis.

"Use of protease inhibitors and tenofovir were significantly associated with bone loss in our study. Osteoporosis is a major problem in this population, and the study suggests that HIV-infected patients with risk factors should have bone mineral density [BMD] monitoring," said Anna Bonjoch, MD, from Lluita Contra La SIDA Foundation at Germans Trias i Pujol, University Hospital, in Barcelona, Spain.

At the opening press conference of ICAAC, Laurent Kaiser, MD, from the University Hospital of Geneva in Switzerland, told the media that new guidelines call for earlier treatment of HIV, and this means that patients will be treated for even longer than they have been previously, increasing the risk for adverse effects. "One of the most important issues in HIV infection is how to treat osteoporosis and cardiovascular disease — 2 major side effects of antiretroviral treatment. We don't have any answers yet," he stated.

To be included in the longitudinal study, subjects had to have documented HIV infection and at least 2 dual-energy x-ray absorptiometry (DXA) scans performed between 2000 and 2009. The study population comprised 391 patients and 1656 DXA scans.

After 3 to 4 years of follow-up, 46% of patients had some degree of bone loss from baseline; 26.83% went from normal BMD to osteopenia, and 19.51% progressed from osteopenia to osteoporosis. At 5-year follow-up, 12.53% had progressed from normal BMD to osteopenia and 15.60% from osteopenia to osteoporosis. In patients with more than 5 years of follow-up, 18% had progressed to osteopenia and 29% to osteoporosis.

Multivariate analysis showed a significant association between progression to osteopenia/osteoporosis and BMD, age, low body mass index, time on protease inhibitor, being male, taking a protease inhibitor at the time of the most recent DXA scan, and time on tenofovir (P < .0001 for all these factors).

At a symposium on the clinical management science of HIV, Todd Brown, MD, assistant professor at Johns Hopkins University in Baltimore, Maryland, said: "We should be worrying about osteoporosis and associated morbidity and mortality. Studies suggest that osteoporosis is 3.5 times more prevalent in patients with HIV than in healthy controls, and interventions when the condition is clinically silent can prevent fractures."

He said that physicians and patients with HIV should be attentive to risk factors for falls, such as sedative use, polypharmacy, and lower extremity neuropathy, all of which are increased in HIV patients.

"All HIV-positive women in menopause and all HIV-positive men aged 50 and older should be screened for BMD," Dr. Brown recommended.

Dr. Bonjoch and Dr. Kaiser have disclosed no relevant financial relationships. Dr. Brown reports financial ties with GSK, Gilead Sciences, ViiV Healthcare, Merck, and Tibotec.

50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Abstract H-226. Presented September 13, 2010.

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