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Schinas G, Schinas I, Ntampanlis G, Polyzou E, Gogos C, Akinosoglou K. Bone Disease in HIV: Need for Early Diagnosis and Prevention. Life (Basel) 2024; 14:522. [PMID: 38672792 PMCID: PMC11051575 DOI: 10.3390/life14040522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The transformation of HIV into a manageable chronic condition has unveiled new clinical challenges associated with aging-related pathologies, including bone disease. This review explores the intricate relationship between HIV, antiretroviral therapy (ART), and bone disease, highlighting the necessity of early diagnosis and preventative strategies to mitigate the increased risk of osteopenia, osteoporosis, and fractures in people living with HIV (PLWHIV). It synthesizes the current literature to elucidate the multifactorial etiology of bone pathology in this population, that includes direct viral effects, chronic immune activation, ART-associated risks, and the impact of traditional risk factors for bone loss. Through a critical examination of modern diagnostic methods, lifestyle modifications, evidence-based preventive actions, and pharmacological treatments, the necessity for comprehensive management is highlighted, along with recommendations for integrated healthcare approaches vital for achieving optimal patient outcomes. By advocating for a proactive, patient-centered, and multidisciplinary strategy, this review proposes a plan to integrate bone health into standard HIV care through active risk identification, vigilant screening, effective preventive measures, tailored treatments, and informed decision-making, in an effort to ultimately enhance the quality of life for PLWHIV.
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Affiliation(s)
- Georgios Schinas
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Ioannis Schinas
- School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Georgios Ntampanlis
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Eleni Polyzou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Charalambos Gogos
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
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Macdonald HM, Maan EJ, Berger C, Côte HCF, Murray MCM, Pick N, Prior JC. Long-Term Change in Bone Mineral Density in Women Living With HIV: A 10-Year Prospective Controlled Cohort Study. JBMR Plus 2023; 7:e10761. [PMID: 37614300 PMCID: PMC10443077 DOI: 10.1002/jbm4.10761] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 08/25/2023] Open
Abstract
Women living with HIV (WLWH) may be at higher risk for osteoporosis and fragility fractures. However, limited prospective data describe long-term trajectories of bone mineral density (BMD) in WLWH versus women without HIV. Thus, in this prospective study, we aimed to compare 10-year change in areal BMD (aBMD) between WLWH (n = 49; 36.8 ± 8.8 years; 96% pre/perimenopausal) and HIV-negative women (population-based controls; n = 49; 41.9 ± 9.2 years; 80% pre/perimenopausal). In an exploratory analysis, we compared fracture history between WLWH and controls. Outcomes were lumbar spine (L1 to L4), total hip, and femoral neck aBMD at baseline and follow-up, which occurred at 13 and 10 years in WLWH and controls, respectively. We fit multivariable regression models to compare baseline and 10-year change in aBMD between groups, adjusting for osteoporosis risk factors. Within WLWH, we examined associations between aBMD and HIV-related factors, including combination antiretroviral therapy (cART) duration. WLWH were diagnosed 6.5 ± 3.7 years before baseline, 80% were on cART for 241 ± 142 weeks, and 49% had HIV plasma viral load <40 copies/mL. Before and after adjusting for osteoporosis risk factors, baseline and 10-year change in aBMD did not differ between WLWH and controls at any site. At baseline, more WLWH than controls reported a history of low-trauma fracture (30% versus 10%, p < 0.05) and major osteoporotic fracture (17% versus 4%, p < 0.05). During follow-up, the number of WLWH and controls with incident fragility fracture was not significantly different. Lifetime cART duration and tenofovir use were not associated with aBMD 10-year percent change. Higher CD4 count at baseline was positively associated with femoral neck aBMD 10-year percent change. Long-term aBMD change in this small WLWH cohort paralleled normal aging, with no evidence of influence from cART use; however, these results should be interpreted with caution given the small sample size. Larger cohort studies are needed to confirm these findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Heather M. Macdonald
- Active Aging Research TeamUniversity of British ColumbiaVancouverBCCanada
- Department of Family PracticeFaculty of Medicine, University of British ColumbiaVancouverBCCanada
| | - Evelyn J. Maan
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
| | - Claudie Berger
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Hélène C. F. Côte
- Department of Pathology & Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
- Centre for Blood ResearchFaculty of Medicine, University of British ColumbiaVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
| | - Melanie C. M. Murray
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Jerilynn C. Prior
- Women's Health Research InstituteVancouverBCCanada
- Centre for Menstrual Cycle and Ovulation Research, Department of Medicine, Division of EndocrinologyUniversity of British ColumbiaVancouverBCCanada
- School of Population and Public HealthFaculty of Medicine, University of British ColumbiaVancouverBCCanada
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Ross RD, Olali AZ, Shi Q, Hoover DR, Sharma A, Weber KM, French AL, McKay H, Tien PC, Yin MT, Rubin LH. Brief Report: Undercarboxylated Osteocalcin Is Associated With Cognition in Women With and Without HIV. J Acquir Immune Defic Syndr 2022; 91:162-167. [PMID: 36094482 PMCID: PMC9470989 DOI: 10.1097/qai.0000000000003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bone loss and cognitive impairment are common in women living with HIV (WLWH) and are exacerbated by menopause. Bone-derived undercarboxylated osteocalcin (ucOCN) and sclerostin appear to influence cognition. The current study investigated whether the circulating levels of these 2 proteins are associated with cognition in midlife WLWH and demographically similar HIV seronegative women. METHODS Plasma samples from women enrolled in a musculoskeletal substudy within the Women's Interagency HIV Study were used to measure ucOCN and sclerostin. A neuropsychological (NP) test battery assessing executive function, processing speed, attention/working memory, learning, memory, verbal fluency, and motor function was administered within 6 months of musculoskeletal enrollment and every 2 years after (1-4 follow-up visits per participant). A series of generalized estimating equations were conducted to examine the association between biomarkers and NP performance at the initial assessment and over time in the total sample and in WLWH only. Primary predictors included biomarkers, time, and biomarker by time interactions. If the interaction terms were not significant, models were re-run without interactions. RESULTS Neither biomarker predicted changes in NP performance over time in the total sample or in WLWH. ucOCN was positively associated with executive function in the total sample and in WLWH and with motor skills in WLWH. ucOCN was negatively associated with attention/working memory in the total sample. There were no significant associations between sclerostin and NP performance. CONCLUSION The current study suggests an association between bone-derived ucOCN and cognition in women with and without HIV infection.
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Affiliation(s)
- Ryan D. Ross
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL
| | - Arnold Z. Olali
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL
| | - Qiuhu Shi
- New York Medical College, Valhalla, NY
| | - Donald R. Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ
| | | | - Kathleen M. Weber
- Cook County Health/CORE Center and Hektoen Institute of Medicine, Chicago, IL
| | - Audrey L French
- Department of Medicine, Stroger Hospital of Cook County/CORE Center, Chicago, IL
| | - Heather McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA
| | | | - Leah H. Rubin
- Department of Neurology, Psychiatry, and Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Baribeau V, Kim CJ, Lorgeoux RP, Brisebois J, Tossonian H, Lachaine J. Healthcare resource utilization and costs associated with renal, bone and cardiovascular comorbidities among persons living with HIV compared to the general population in Quebec, Canada. PLoS One 2022; 17:e0262645. [PMID: 35816474 PMCID: PMC9273062 DOI: 10.1371/journal.pone.0262645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
There is limited understanding on healthcare utilization and costs of age-related comorbidities such as cardiovascular, bone and renal disease/disorder in people living with human immunodeficiency virus, so we compared comorbidity prevalence and associated healthcare utilization and costs. Through the Quebec health insurance database, people living with human immunodeficiency virus on antiretroviral therapy for ≥6 months from January 2006 to June 2012 were categorized by their comorbidity status using International Classification of Diseases (ICD)-9 codes, and controls without human immunodeficiency virus diagnosis or antiretroviral therapy use were age and gender matched. We compared healthcare utilization and costs. A total of 3,905 people living with human immunodeficiency virus and 11,715 control individuals were included. The mean age of people living with human immunodeficiency virus was 45.3 years and 77.3% were men. Prevalence of comorbidities was higher and occurred earlier in people living with human immunodeficiency virus and increased with older age regardless of human immunodeficiency virus status. Interestingly, bone comorbidity was high (37%) and 5-fold greater in people living with human immunodeficiency virus <20 years than the controls. Polypharmacy and comorbidity scores were greater in people living with human immunodeficiency virus than controls (p<0.01), as were cardiovascular, bone and renal comorbidities (40.3%, 26.0% and 5.5%, respectively; p<0.01). People living with human immunodeficiency virus had higher healthcare utilization and costs than controls largely due to longer hospital stays and prescriptions. Mean total healthcare cost/person/year for people living with human immunodeficiency virus was CAD$6,248 and was highest for those with renal disease (CAD$19,617). Comorbidities in people living with human immunodeficiency virus are more prevalent, occur earlier and incur a higher burden on the healthcare system; earlier screening and improved preventative and management strategies may reduce the burden to people living with human immunodeficiency virus and to the healthcare system.
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Affiliation(s)
| | - Connie J. Kim
- Gilead Sciences Canada, Inc, Mississauga, Ontario, Canada
| | | | | | | | - Jean Lachaine
- PeriPharm Inc, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
- * E-mail:
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Sakai M, Higashi M, Fujiwara T, Uehira T, Shirasaka T, Nakanishi K, Kashiwagi N, Tanaka H, Terada H, Tomiyama N. MRI imaging features of HIV-related central nervous system diseases: diagnosis by pattern recognition in daily practice. Jpn J Radiol 2021; 39:1023-1038. [PMID: 34125369 PMCID: PMC8202053 DOI: 10.1007/s11604-021-01150-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/01/2021] [Indexed: 01/10/2023]
Abstract
With the advent of antiretroviral therapy (ART), the prognosis of people infected with human immunodeficiency virus (HIV) has improved, and the frequency of HIV-related central nervous system (CNS) diseases has decreased. Nevertheless, mortality from HIV-related CNS diseases, including those associated with ART (e.g., immune reconstitution inflammatory syndrome) remains significant. Magnetic resonance imaging (MRI) can improve the outlook for people with HIV through early diagnosis and prompt treatment. For example, HIV encephalopathy shows a diffuse bilateral pattern, whereas progressive multifocal leukoencephalopathy, HIV-related primary CNS lymphoma, and CNS toxoplasmosis show focal patterns on MRI. Among the other diseases caused by opportunistic infections, CNS cryptococcosis and CNS tuberculosis have extremely poor prognoses unless diagnosed early. Immune reconstitution inflammatory syndrome shows distinct MRI findings from the offending opportunistic infections. Although distinguishing between HIV-related CNS diseases based on imaging alone is difficult, in this review, we discuss how pattern recognition approaches can contribute to their early differentiation.
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Affiliation(s)
- Mio Sakai
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan.
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka-shi, Osaka, 540-0006, Japan
| | - Takuya Fujiwara
- Department of Radiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka-shi, Osaka, 540-0006, Japan
| | - Tomoko Uehira
- AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka-shi, Osaka, 540-0006, Japan
| | - Takuma Shirasaka
- AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka-shi, Osaka, 540-0006, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan
| | - Nobuo Kashiwagi
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hisashi Tanaka
- Department of Radiology, Osaka University Graduate School of Medicine, 2‑2, Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - Hitoshi Terada
- Department of Radiology, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2‑2, Yamadaoka, Suita, Osaka, 565‑0871, Japan
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Mwasakifwa GE, Amin J, White CP, Center JR, Kelleher A, Boyd MA. Early changes in bone turnover and inflammatory biomarkers and clinically significant bone mineral density loss over 48 weeks among HIV-infected patients with virological failure of a standard first-line antiretroviral therapy regimen in the SECOND-LINE study. HIV Med 2020; 21:492-504. [PMID: 32573910 DOI: 10.1111/hiv.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/31/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We assessed whether changes at week 12 in markers of bone turnover, inflammation, and immune activation were associated with clinically important (≥ 5%) bone mineral density (BMD) loss from baseline to week 48 at the proximal femur (hip) and lumbar spine in the SECOND-LINE study. METHODS We measured concentrations of procollagen type 1 pro-peptide (P1NP), carboxyl-terminal collagen crosslinks (CTX), high-sensitivity C-reactive protein (hs-CRP), D-dimer, interleukin (IL)-6, tumor necrosis factor (TNF), neopterin, and soluble CD14 and 163 at weeks 0, 12, and 48 in 123 SECOND-LINE dual-energy X-ray absorptiometry (DXA) substudy participants. Linear regression was used to compare changes in biomarkers. Predictors of ≥ 5% BMD loss were examined using multivariable regression. RESULTS The mean age was 38 years, the mean CD4 T-cell count was 252 cells/µL and the mean viral load was 4.2 log HIV-1 RNA copies/mL; 56% of participants were female and 47% were randomized to receive a nucleos(t)ide reverse transcriptase inhibitor [N(t)RTI]-based regimen [91% (53/58) were randomized to receive a tenofovir disoproxil fumarate (TDF)-containing regimen]. Over 48 weeks, 71% in the N(t)RTI arm experienced ≥ 5% hip BMD loss vs. 29% in the raltegravir arm (P = 0.001). Week 12 changes in P1NP and CTX were significantly greater among patients experiencing ≥ 5% hip BMD loss, patients randomized to N(t)RTI, and male patients. Predictors of ≥ 5% hip BMD loss at week 48 were P1NP increase [odds ratio (OR) 5.0; 95% confidence interval (CI) 1.1-27; P < 0.043]; N(t)RTI randomization (OR 6.7; 95% CI 2.0-27.1; P < 0.003), being African, higher baseline CD4 T cell count , and smoking. CONCLUSIONS In a diverse cohort of viraemic HIV-infected patients, switching to second-line antiretroviral therapy (ART) was associated with clinically significant BMD loss, which was correlated with an early increase in P1NP. Measurement of P1NP may facilitate timely interventions to reduce rapid BMD loss among at-risk patients.
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Affiliation(s)
- G E Mwasakifwa
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J Amin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia
| | - C P White
- Department of Endocrinology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - J R Center
- The Garvan Institute of Medical Research, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - A Kelleher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - M A Boyd
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Ross RD, Sharma A, Shi Q, Hoover DR, Weber KM, Tien PC, French AL, Al-Harthi L, Yin MT. Circulating sclerostin is associated with bone mineral density independent of HIV-serostatus. Bone Rep 2020; 12:100279. [PMID: 32455152 PMCID: PMC7235609 DOI: 10.1016/j.bonr.2020.100279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 01/14/2023] Open
Abstract
Background Low bone mineral density (BMD) is commonly observed in people living with HIV (PLWH), however the cause for this BMD loss remains unclear. Sclerostin, a bone-derived antagonist to the Wnt/β-catenin-pathway, suppresses bone remodeling and is positively associated with BMD. The goal of the current study was to investigate associations between sclerostin and BMD in a cohort of HIV-seropositive and demographically-matched seronegative women. Methods This cross-sectional analysis used a subset of early postmenopausal women enrolled in the Women's Interagency HIV Study (WIHS). BMD was assessed at the lumbar spine, total hip, femoral neck, and distal and ultradistal radius via dual energy x-ray absorptiometry (DXA). Circulating sclerostin was assessed via commercial ELISAs. Univariate and multivariate linear regression modeling tested associations between sclerostin and BMD after adjusting for a variety of BMD-modifying variables. Results HIV-seropositive women had significantly reduced BMD at all skeletal sites compared to HIV-seronegative women. There was no difference in sclerostin levels according to HIV-serostatus (0.25 vs 0.27 ng/mL in HIV-seronegative and HIV-seropositive, respectively, p = 0.71). Circulating sclerostin was positively associated with BMD at all sites in both univariate and multivariate models adjusting for HIV status, age, BMI, and race, although the coefficients of association were attenuated in HIV-seropositive women. The positive association between sclerostin and BMD among seropositive women remained statistically significant after adjusting for ART or tenofovir disoproxil fumarate (TDF) use. Conclusions The current study suggests that circulating sclerostin is a biomarker for bone mass for both HIV seronegative and seropositive women using and not using ART. The lower coefficients of association between sclerostin and BMD by HIV status may suggest HIV-induced alternation in osteocyte function.
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Affiliation(s)
- Ryan D. Ross
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America
- Corresponding author.
| | - Anjali Sharma
- State University of New York, Downstate, Brooklyn, NY, United States of America
| | - Qiuhu Shi
- New York Medical College, Valhalla, NY, United States of America
| | - Donald R. Hoover
- Department of Statistics and Institute for Health Health Care Policy and Aging Research Rutgers University, Piscataway, NJ, United States of America
| | - Kathleen M. Weber
- Cook County Health/CORE Center and Hektoen Institute of Medicine, Chicago, IL, United States of America
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, United States of America
| | - Audrey L. French
- Department of Medicine, Stroger Hospital of Cook County/CORE Center, Rush University, Chicago, IL, United States of America
| | - Lena Al-Harthi
- Department of Microbial Pathogens and immunity, Rush University Medical Center, Chicago, IL, United States of America
| | - Michael T. Yin
- Columbia University Medical Center, New York, NY, United States of America
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Abstract
OBJECTIVES To determine the incidence of fracture among aging HIV-infected (HIV+) and uninfected men (HIV-). To evaluate factors independently associated with fracture risk. DESIGN Prospective, multicenter cohort study of men with or at risk for HIV. METHODS Outcome measures: all fractures (excluding skull, face and digits) and fragility fractures (vertebral column, femur, wrist and humerus) were collected semiannually in 1221 HIV+ and 1408 HIV- men aged at least 40. Adjusted incident rate ratios (aIRR) with an interaction term for age (40-49, 50-59 and ≥60 years) and HIV serostatus were estimated with Poisson regression models accounting for additional risk factors. RESULTS Fracture incidence increased with age among both HIV+ and HIV- men. Although there was no significant difference in fracture incidence by HIV serostatus among men aged 40-49 years, the HIV+ men aged 50-59 years had a significantly higher incidence of all fractures [aIRR: 2.06 (1.49, 2.84)] and fragility fractures [aIRR: 2.06 (1.21, 3.50)] compared with HIV- participants of similar age. HIV modified the effect of age on all fractures (P = 0.002) but did not significantly modify the effect for fragility fractures (P = 0.135). Hypertension increased the rate of all fractures by 32% after adjustment for covariates [aIRR: 1.32 (1.04, 1.69)]. CONCLUSION Fracture incidence increased with age among HIV+ and HIV- men but was higher among HIV+ men. A significant increase in fracture incidence was found among 50-59-year-old HIV+ men, highlighting the importance of osteoporosis screening for HIV-infected men above the age of 50.
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10
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Pathophysiology of hemophilic arthropathy and potential targets for therapy. Pharmacol Res 2017; 115:192-199. [DOI: 10.1016/j.phrs.2016.11.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 01/14/2023]
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Abstract
The success of antiretroviral therapy in treating HIV infection has greatly prolonged life expectancy in affected individuals, transforming the disease into a chronic condition. A number of HIV-associated non-AIDS comorbidities have emerged in the ageing HIV-infected population, including osteoporosis and increased risk of fracture. The pathogenesis of fracture is multifactorial with contributions from both traditional and HIV-specific risk factors. Significant bone loss occurs on initiation of antiretroviral therapy but stabilizes on long-term therapy. Fracture risk assessment should be performed in HIV-infected individuals and bone mineral density measured when indicated. Lifestyle measures to optimize bone health should be advised and, in individuals at high risk of fracture, treatment with bisphosphonates considered.
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Affiliation(s)
- J Compston
- Dept of Medicine, Cambridge Biomedical Campus Francis Crick Ave, Cambridge CB2 0SL, UK.
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Compston J. HIV infection and osteoporosis. BONEKEY REPORTS 2015; 4:636. [PMID: 25709813 PMCID: PMC4325555 DOI: 10.1038/bonekey.2015.3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/07/2015] [Indexed: 01/05/2023]
Abstract
In the past two decades, the life expectancy of people living with HIV infection has increased significantly, and osteoporosis has emerged as a significant comorbidity. In addition to traditional risk factors for fracture, specific factors related to HIV infection are also likely to contribute, including antiretroviral therapy. The heterogeneity of the HIV-infected population in terms of age and ethnicity presents many challenges to the prevention and management of bone disease, and further studies are required to establish optimal approaches to risk assessment and treatment.
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Affiliation(s)
- Juliet Compston
- Department of Medicine, Cambridge Biomedical Campus, Cambridge, UK
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Compston J. Osteoporosis and fracture risk associated with HIV infection and treatment. Endocrinol Metab Clin North Am 2014; 43:769-80. [PMID: 25169566 DOI: 10.1016/j.ecl.2014.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoporosis has emerged as an important co-morbidity of HIV infection and a modest increase in fracture risk has been documented. Bone loss from the spine and hip occurs after initiation of antiretroviral therapy but most data indicate that bone mineral density is stable in HIV-infected individuals established on long-term antiretroviral therapy. Assessment of fracture probability should be performed in individuals who have clinical risk factors for fracture. Adequate dietary calcium intake and vitamin D status should be ensured and in individuals with a high fracture probability, bisphosphonate therapy may be appropriate.
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Affiliation(s)
- Juliet Compston
- Department of Medicine, Addenbrookes Hospital, Cambridge Biomedical Campus, Box 157, Cambridge CB2 0QQ, UK.
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O'Brien KK, Solomon P, Trentham B, MacLachlan D, MacDermid J, Tynan AM, Baxter L, Casey A, Chegwidden W, Robinson G, Tran T, Wu J, Zack E. Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis. BMJ Open 2014; 4:e004692. [PMID: 24833687 PMCID: PMC4024604 DOI: 10.1136/bmjopen-2013-004692] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Our aim was to develop evidence-informed recommendations for rehabilitation with older adults living with HIV. DESIGN We conducted a knowledge synthesis, combining research evidence specific to HIV, rehabilitation and ageing, with evidence on rehabilitation interventions for common comorbidities experienced by older adults with HIV. METHODS We included highly relevant HIV-specific research addressing rehabilitation and ageing (stream A) and high-quality evidence on the effectiveness of rehabilitation interventions for common comorbidities experienced by older adults ageing with HIV (stream B). We extracted and synthesised relevant data from the evidence to draft evidence-informed recommendations for rehabilitation. Draft recommendations were refined based on people living with HIV (PLHIV) and clinician experience, values and preferences, reviewed by an interprofessional team for Grading of Recommendations Assessment, Development, and Evaluation (GRADE) (quality) rating and revision and then circulated to PLHIV and clinicians for external endorsement and final refinement. We then devised overarching recommendations to broadly guide rehabilitation with older adults living with HIV. RESULTS This synthesis yielded 8 overarching and 52 specific recommendations. Thirty-six specific recommendations were derived from 108 moderate-level or high-level research articles (meta-analyses and systematic reviews) that described the effectiveness of rehabilitation interventions for comorbidities that may be experienced by older adults with HIV. Recommendations addressed rehabilitation interventions across eight health conditions: bone and joint disorders, cancer, stroke, cardiovascular disease, mental health challenges, cognitive impairments, chronic obstructive pulmonary disease and diabetes. Sixteen specific recommendations were derived from 42 research articles specific to rehabilitation with older adults with HIV. The quality of evidence from which these recommendations were derived was either low or very low, consisting primarily of narrative reviews or descriptive studies with small sample sizes. Recommendations addressed approaches to rehabilitation assessment and interventions, and contextual factors to consider for rehabilitation with older adults living with HIV. CONCLUSIONS These evidence-informed recommendations provide a guide for rehabilitation with older adults living with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Canadian Working Group on HIV and Rehabilitation, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Barry Trentham
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Larry Baxter
- Canadian Working Group on HIV and Rehabilitation, Toronto, Ontario, Canada
| | - Alan Casey
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William Chegwidden
- National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
| | - Greg Robinson
- Canadian Working Group on HIV and Rehabilitation, Toronto, Ontario, Canada
| | - Todd Tran
- Women's College Hospital, Toronto, Ontario, Canada
| | - Janet Wu
- St Michael's Hospital, Toronto, Ontario, Canada
| | - Elisse Zack
- Canadian Working Group on HIV and Rehabilitation, Toronto, Ontario, Canada
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Hamill MM, Ward KA, Pettifor JM, Norris SA, Prentice A. Bone mass, body composition and vitamin D status of ARV-naïve, urban, black South African women with HIV infection, stratified by CD₄ count. Osteoporos Int 2013; 24:2855-61. [PMID: 23719859 PMCID: PMC3841578 DOI: 10.1007/s00198-013-2373-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/28/2013] [Indexed: 11/26/2022]
Abstract
UNLABELLED This is the first report examining vitamin D status and bone mass in African women with HIV infection using dual-energy X-ray absorptiometry (DXA) with an appropriate HIV-negative control group. Unlike previous publications, it demonstrates no difference in bone mineral density (BMD) or vitamin D status in HIV-positive patients, at different disease stages, vs. HIV-negative subjects. INTRODUCTION Low bone mass and poor vitamin D status have been reported among HIV-positive patients; suggesting HIV or its treatment may increase the risk of osteoporosis, a particular concern for women in countries with high HIV prevalence such as South Africa. We describe bone mass and vitamin D status in urban premenopausal South African women, who were HIV positive but not on antiretroviral therapy (ARV). METHODS This study is a cross-sectional measurement of BMD and body composition by DXA and vitamin D status by serum 25-hydroxyvitamin D (25(OH)D) concentration. Subjects were recruited into three groups: HIV negative (n = 98) and HIV positive with preserved CD₄ cell count (non-ARV; n = 74) or low CD₄ cell counts prior to ARV initiation (pre-ARV; n = 75). RESULTS The mean (standard deviation (SD)) age of women was 32.1 (7.2) years. Mean CD₄ (SD) counts (×10(6)/l) were 412 (91) and 161 (69) in non-ARV and pre-ARV groups (p < 0.0001). Pre-ARV women were significantly lighter and had lower mean BMI than the other two groups (p < 0.002). The pre-ARV group also had significantly less fat and lean mass compared with non-ARV and HIV-negative subjects (p ≤ 0.05). After full adjustment, there were no significant differences in BMD at any site (p > 0.05) between the groups, nor was vitamin D status significantly different between groups (p > 0.05); the mean (SD) cohort 25(OH)D being 60 (18) nmol/l. CONCLUSION Contrary to previous studies, these HIV-positive women did not have lower BMD or 25(OH)D concentrations than HIV-negative controls, despite the pre-ARV group being lighter with lower BMI.
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Affiliation(s)
- M M Hamill
- MRC Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, CB1 9NL, Cambridge, UK,
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16
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A cross-sectional randomised study of fracture risk in people with HIV infection in the probono 1 study. PLoS One 2013; 8:e78048. [PMID: 24205086 PMCID: PMC3812175 DOI: 10.1371/journal.pone.0078048] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/08/2013] [Indexed: 11/26/2022] Open
Abstract
Objective To determine comparative fracture risk in HIV patients compared with uninfected controls. Design A randomised cross-sectional study assessing bone mineral density (BMD), fracture history and risk factors in the 2 groups. Setting Hospital Outpatients. Subbbjects 222 HIV infected patients and an equal number of age-matched controls. Assessments: Fracture risk factors were assessed and biochemical, endocrine and bone markers measured. BMD was assessed at hip and spine. 10-year fracture probability (FRAX) and remaining lifetime fracture probability (RFLP) were calculated. Main Outcome Measures BMD, and history of fractures. Results Reported fractures occurred more frequently in HIV than controls, (45 vs. 16; 20.3 vs. 7%; OR=3.27; p=0.0001), and unsurprisingly in this age range, non-fragility fractures in men substantially contributed to this increase. Osteoporosis was more prevalent in patients with HIV (17.6% vs. 3.6%, p<0.0001). BMD was most reduced, and predicted fracture rates most increased, at the spine. Low BMD was associated with antiretroviral therapy (ART), low body mass index and PTH. 10-year FRAX risk was <5% for all groups. RLFP was greater in patients with HIV (OR=1.22; p=0.003) and increased with ART (2.4 vs. 1.50; OR= 1.50; p=0.03). Conclusions The increased fracture rate in HIV patients in our relatively youthful population is partly driven by fractures, including non-fragility fractures, in men. Nonetheless, these findings may herald a rise in osteoporotic fractures in HIV patients. An appropriate screening and management response is required to assess these risks and identify associated lifestyle factors that are also associated with other conditions such as cardiovascular disease and diabetes.
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17
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Molecular Bases of Osteoporosis in HIV: The Role of the Virus and Antiretroviral Therapy. Clin Rev Bone Miner Metab 2012. [DOI: 10.1007/s12018-012-9133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Yin MT, Zhang CA, McMahon DJ, Ferris DC, Irani D, Colon I, Cremers S, Shane E. Higher rates of bone loss in postmenopausal HIV-infected women: a longitudinal study. J Clin Endocrinol Metab 2012; 97:554-62. [PMID: 22090266 PMCID: PMC3275353 DOI: 10.1210/jc.2011-2197] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT AND OBJECTIVE The objective of the study was to assess the effects of HIV infection and antiretroviral therapy on change in bone mineral density (BMD) in postmenopausal minority women. DESIGN, SETTING, AND PATIENTS We report a longitudinal analysis of change in BMD with a median duration of 15.4 (interquartile range 13.1, 20.7) months in a prospective cohort study of 128 (73 HIV+, 55 HIV-) postmenopausal Hispanic and African-American women. MAIN OUTCOME MEASURES Annualized change in BMD by dual-energy x-ray absorptiometry and correlation with baseline markers of bone turnover and serum levels of inflammatory cytokines were measured. RESULTS HIV+ women were younger (56 ± 1 vs. 59 ± 1 yr, P < 0.05) and had lower body mass index (BMI; 28 ± 1 vs. 31 ± 1 kg/m(2), P < 0.01). The majority of HIV+ women were on established antiretroviral therapy for more than 3 yr. At baseline, BMD, adjusted for age, race, and BMI, was lower in HIV+ women at the lumbar spine (LS), total hip, and radius and serum C-telopeptide was higher. Annualized rates of bone loss adjusted for baseline BMD were higher in HIV+ women by 2.4-fold at the LS (-1.2 ± 0.3% vs. -0.5 ± 0.3%, P = 0.0009), 3.7-fold at the one third radius (-1.1 ± 0.2% vs. -0.3 ± 0.2, P = 0.006) and 1.7-fold at the ultradistal radius (-1.2 ± 0.2% vs. -0.7 ± 0.2%, P = 0.02). In multivariate analysis, HIV+ status predicted bone loss at the LS, total hip, and ultradistal radius. Among HIV+ women, lower BMI, higher markers of bone turnover levels, and tenofovir were associated with more bone loss. CONCLUSION HIV+ postmenopausal minority women had lower BMD, increased bone turnover, and higher rates of bone loss than HIV- women. These features may place these women at increased risk for fracture as they age.
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Affiliation(s)
- Michael T Yin
- Columbia University Medical Center, New York, New York 10032, USA.
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19
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The success of endosseous implants in human immunodeficiency virus–positive patients receiving antiretroviral therapy. J Am Dent Assoc 2011; 142:1010-6. [DOI: 10.14219/jada.archive.2011.0320] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Young B, Dao CN, Buchacz K, Baker R, Brooks JT. Increased rates of bone fracture among HIV-infected persons in the HIV Outpatient Study (HOPS) compared with the US general population, 2000-2006. Clin Infect Dis 2011; 52:1061-8. [PMID: 21398272 DOI: 10.1093/cid/ciq242] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Among persons with HIV infection, low bone mineral density is common and has raised concerns about increased risk of fracture. METHODS We analyzed data from the HIV Outpatient Study (HOPS), an open prospective cohort study of HIV-infected adults who were followed up at 10 US HIV clinics. We assessed rates of first fractures at any anatomic site during the period 2000-2008. We indirectly standardized the rates of fracture in the HOPS to the general population by age and sex, using data from outpatients in the National Hospital Ambulatory Medical Care Survey (NHAMCS-OPD). We examined factors associated with fractures using Cox proportional hazards modeling. RESULTS Among 5826 active HOPS patients whose data were analyzed (median baseline age, 40 years; male sex, 79%; white race, 52%; exposure to antiretroviral therapy, 73%), 233 patients had incident fractures (crude annual rates, 59.6-93.5 fractures per 10,000 persons). Age-standardized fracture rates increased from 2000 to 2002 (P = .01) and stabilized thereafter. Among persons aged 25-54 years, both fracture rates and relative proportion of fragility fractures were higher among HOPS patients than among patients in the NHAMCS-OPD. In addition to older age and substance abuse, nadir CD4+ cell count <200 cells/mm(3) (adjusted hazard ratio [aHR], 1.60; 95% confidence interval [CI], 1.11-2.31), hepatitis C infection (aHR, 1.61; 95% CI, 1.13-2.29) and diabetes (aHR, 1.62; 95% CI, 1.00-2.64) were associated with incident fractures. CONCLUSIONS Age-adjusted fracture rates among HOPS patients were higher than rates in the general US population during the period 2000-2006. Clinicians should regularly assess HIV-infected persons for fracture risk, especially those with low nadir CD4+ cell counts or other established risk factors for fracture.
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21
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Nonsurgical Management of Severe Osteonecrosis of the Knee in an HIV-Positive Patient: A Case Report. Case Rep Infect Dis 2011; 2011:935041. [PMID: 22570802 PMCID: PMC3336249 DOI: 10.1155/2011/935041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 06/07/2011] [Indexed: 11/17/2022] Open
Abstract
Due to the life-prolonging effects of combination antiretroviral therapy, many people with HIV are living longer. However, this enhanced longevity is often mirrored by increased disability resulting from HIV and/or the adverse effects of medication. Management of HIV-positive patients is further complicated by comorbidities related to aging, including bone and joint disorders. In this paper, we describe the nonsurgical management of an HIV-positive patient with premature onset of severe osteonecrosis of the knee. A 50-year-old man who had been HIV-positive for 16 years and on combination antiretroviral therapy for 11 years presented to his family physician with extreme discomfort in his right knee. He was diagnosed with osteonecrosis of the right knee, but resisted total knee arthroplasty because of potential complications under anesthesia related to comorbid advanced liver disease. Instead, a successful combination of non-surgical management strategies was employed by the patient and his health care team.
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Abstract
OBJECTIVE(S) To identify factors (including exposure to specific antiretroviral drugs) associated with severe vitamin D deficiency (VDD) in HIV-infected individuals and to explore the effects of severe VDD and antiretroviral drug exposure on serum alkaline phosphatase (ALP) as surrogate marker of bone turnover. DESIGN Cross-sectional survey of vitamin D status among HIV-infected patients attending for routine clinical care at a large London HIV clinic. METHODS Severe VDD was defined as 25(OH)D levels of less than 10 microg/l (<25 nmol/l). Multivariate logistic regression analysis was used to identify factors associated with severe VDD and upper quartile ALP levels. RESULTS Vitamin D levels were measured in 1077 patients and found to be suboptimal in 91%. One-third of patients had severe VDD. Black ethnicity, sampling in winter, nadir CD4 cell count less than 200 cells/microl, and exposure to combination antiretroviral therapy were associated with severe VDD. In analyses restricted to patients on combination antiretroviral therapy, current efavirenz use was significantly associated with severe VDD [adjusted odds ratio 2.0 (95% confidence interval 1.5-2.7)]. Current tenofovir [adjusted odds ratio 3.5 (95% confidence interval 2.3-5.2)] and efavirenz use [adjusted odds ratio 1.6 (95% confidence interval 1.02-2.4)], but not severe VDD [odds ratio 1.1 (0.8-1.5)], were associated with increased bone turnover (upper quartile ALP). CONCLUSION Efavirenz was associated with severe VDD, a condition associated with multiple adverse health outcomes, and efavirenz and tenofovir with increased ALP. The clinical significance of these findings requires further investigation, given the widespread use of efavirenz and tenofovir in first-line combination antiretroviral therapy.
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23
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Vestergaard P. Adverse Effects of Drugs on Bone and Calcium Metabolism/Physiology. Clin Rev Bone Miner Metab 2008. [DOI: 10.1007/s12018-007-9002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bolland MJ, Grey AB, Gamble GD, Reid IR. CLINICAL Review # : low body weight mediates the relationship between HIV infection and low bone mineral density: a meta-analysis. J Clin Endocrinol Metab 2007; 92:4522-8. [PMID: 17925333 DOI: 10.1210/jc.2007-1660] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT HIV infection has been associated with low bone mineral density (BMD) in many cross-sectional studies, although longitudinal studies have not demonstrated accelerated bone loss. The cross-sectional studies may have been confounded by the failure to control for low body weight in HIV-infected patients. OBJECTIVE Our objective was to determine whether low body weight might explain the association of HIV infection with low BMD. DATA SOURCES MEDLINE and EMBASE were searched for English language studies published from 1966 to March 2007, and conference abstracts prior to 2007 were hand-searched. STUDY SELECTION All studies reporting BMD and weight or body mass index in adult patients with HIV and a healthy age- and sex-comparable control group were included. Nine of 40 identified studies and one of 68 identified abstracts were eligible. DATA SYNTHESIS We adjusted for the between-groups weight differences using regression coefficients from published cohorts of healthy men and women. On average, HIV-infected patients were 5.1 kg [95% confidence interval (CI), -6.8, -3.4; P < 0.001] lighter than controls. At all skeletal sites, unadjusted BMD was lower by 4.4-7.0% in the HIV-infected groups than the controls (P < 0.01). After adjustment for body weight, residual between-groups differences in BMD were small (2.2-4.7%) [lumbar spine, -0.02 (95% CI, -0.05, 0.01) g/cm2; P = 0.12; total hip, -0.02 (95% CI, -0.04, 0.00) g/cm2; P = 0.031; femoral neck, -0.04 (95% CI, -0.07, -0.01) g/cm2; P = 0.013; and total body, -0.03 (95% CI, -0.07, 0.01) g/cm2, P = 0.11]. CONCLUSION HIV-infected patients are lighter than controls and low body weight may largely account for the high prevalence of low BMD reported in HIV-infected patients. However, in the setting of current treatment practice, HIV infection per se is not a risk factor for low BMD.
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Affiliation(s)
- Mark J Bolland
- Osteoporosis Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland, New Zealand.
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25
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Alendronate with calcium and vitamin D supplementation is safe and effective for the treatment of decreased bone mineral density in HIV. AIDS 2007; 21:2473-82. [PMID: 18025884 DOI: 10.1097/qad.0b013e3282ef961d] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decreased bone mineral density (BMD) is prevalent in HIV-infected patients. Bisphosphonates are currently the mainstay of treatment for postmenopausal and male osteoporosis in HIV-uninfected individuals; however, their efficacy and safety in HIV-infected patients remains unclear. METHODS In this prospective, randomized, placebo-controlled multicenter trial, we studied the effectiveness of calcium and vitamin D supplementation with or without alendronate in improving BMD in HIV-infected subjects receiving stable antiretroviral therapy. Subjects with secondary causes of osteoporosis were excluded. The study was powered to detect differences of 3.5% between arms and to detect a moderate sex effect in percentage change in lumbar spine BMD. All dual-energy X-ray absorptiometry scans were analysed centrally, blinded by arm. RESULTS The 82 subjects enrolled were 71% men, 77% white, with a baseline median age of 48 years, CD4 cell count of 469 cells/mul, and lumbar spine t-score of less than 2.1; 91% had HIV-RNA levels less than 400 copies/ml, and 99% were taking antiretroviral drugs. Compared with calcium/vitamin D alone, alendronate plus calcium/vitamin D resulted in significant improvements in BMD at the lumbar spine, total hip, and trochanter, but not at the femoral neck, compared with baseline. There were trends towards significant increases in BMD values in the calcium/vitamin D group at the lumbar spine, total hip, and femoral neck. There were no apparent sex differences in the responses to therapy. Alendronate was well tolerated, without significant adverse events. CONCLUSION Once-weekly alendronate is safe and effective in the treatment of decreased BMD in HIV-infected patients.
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Prevalence and risk factors for osteopenia/osteoporosis in an HIV-infected male population. Wien Klin Wochenschr 2007; 119:639-46. [DOI: 10.1007/s00508-007-0844-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 06/18/2007] [Indexed: 10/22/2022]
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Nestorowicz A, Cameron S. Key reports from the 9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 2007. Antivir Ther 2007. [DOI: 10.1177/135965350701200617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV provided a forum for the presentation of basic and clinical research focused on the pathogenesis and management of lipodystrophy and other adverse events associated with antiretroviral therapy. New data were reported on the contribution of both antiretroviral therapy and HIV infection itself on the development of metabolic abnormalities in patients with lipodystrophy, including insulin resistance and dyslipidaemia, which are associated with an increased risk of diabetes and cardiovascular disease. In addition, an emerging role of HIV and antiretroviral therapy in bone, liver and kidney disease were highlighted. A major focus of the data presented in these areas concerned the identification and evaluation of risk factors and appropriate surrogate markers for defining cardiovascular disease risk as well as other outcomes of long-term treatment. The complexity of defining such risk factors was underscored by data describing the impact of race, age and gender in the progression of metabolic disease and related complications among different HIV-infected populations. Finally, advances in the development of pharmacovigilance reporting systems in resource-limited settings and their impact upon healthcare policies and the provision of patient care were also described.
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Bolland MJ, Grey AB, Horne AM, Briggs SE, Thomas MG, Ellis-Pegler RB, Woodhouse AF, Gamble GD, Reid IR. Annual zoledronate increases bone density in highly active antiretroviral therapy-treated human immunodeficiency virus-infected men: a randomized controlled trial. J Clin Endocrinol Metab 2007; 92:1283-8. [PMID: 17227801 DOI: 10.1210/jc.2006-2216] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Recent studies have reported low bone mineral density (BMD) in HIV-infected patients. Annual iv administration of 4 mg zoledronate has been shown to increase BMD and suppress bone turnover in postmenopausal women. OBJECTIVE The objective of the study was to determine whether annual administration of 4 mg zoledronate will increase BMD in HIV-infected men receiving highly active antiretroviral therapy. DESIGN AND SETTING A 2-yr randomized placebo-controlled trial was conducted in a clinical research center. PARTICIPANTS A total of 43 HIV-infected men were treated with highly active antiretroviral therapy for at least 3 months, with BMD T score less than -0.5. INTERVENTION Participants received annual iv administration of 4 mg zoledronate or placebo. All participants took 400 mg/d calcium and 1.25 mg/month vitamin D. MEASUREMENTS BMD at the lumbar spine, total hip and total body, and bone turnover markers were measured. RESULTS At the lumbar spine, BMD increased by 8.9% over 2 yr in the zoledronate group compared with an increase of 2.6% in the control group (P<0.001). At the total hip, BMD increased by 3.8% over 2 yr in the zoledronate group compared with a decrease of 0.8% in the control group (P<0.001). At the total body, BMD increased by 2.3% over 2 yr compared with a decrease of 0.5% in the control group (P<0.001). Urine N-telopeptide decreased by 60% at 3 months in the zoledronate group and thereafter remained stable. CONCLUSIONS Annual administration of zoledronate is a potent and effective therapy for the prevention or treatment of bone loss in HIV-infected men. The current data provide the first trial evidence of the BMD effects of annual zoledronate beyond 1 yr in any population, as well as being the first reported trial in men.
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Affiliation(s)
- Mark J Bolland
- Department of Medicine, University of Auckland, and Department of Infectious Diseases, Auckland Hospital, New Zealand.
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Wohl DA, McComsey G, Tebas P, Brown TT, Glesby MJ, Reeds D, Shikuma C, Mulligan K, Dube M, Wininger D, Huang J, Revuelta M, Currier J, Swindells S, Fichtenbaum C, Basar M, Tungsiripat M, Meyer W, Weihe J, Wanke C. Current concepts in the diagnosis and management of metabolic complications of HIV infection and its therapy. Clin Infect Dis 2006; 43:645-53. [PMID: 16886161 DOI: 10.1086/507333] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 06/08/2006] [Indexed: 12/12/2022] Open
Abstract
Changes in fat distribution, dyslipidemia, disordered glucose metabolism, and lactic acidosis have emerged as significant challenges to the treatment of human immunodeficiency virus (HIV) infection. Over the past decade, numerous investigations have been conducted to better define these conditions, identify risk factors associated with their development, and test potential therapeutic interventions. The lack of standardized diagnostic criteria, as well as disparate study populations and research methods, have led to conflicting data regarding the diagnosis and treatment of metabolic and body shape disorders associated with HIV infection. On the basis of a review of the medical literature published and/or data presented before April 2006, we have prepared a guide to assist the clinician in the detection and management of these complications.
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Affiliation(s)
- D A Wohl
- Div. of Infectious Diseases, University of North Carolina, Chapel Hill, NC 27599, USA.
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