Impact of HIV-1 Infection and Antiretroviral Therapy on Bone Homeostasis and Mineral Density in Vertically Infected Patients

Fracture Risk with Modified FRAX in Men Living with HIV

BACKGROUND

Aging of the HIV-infected population and prolonged use of ARTs, produced metabolic alterations, including increased fracture risk. FRAX is a validated, computer-based clinical fracture risk calculator which estimates 10-year risk of major fracture, and hip fracture. However may underestimate risk in HIV-infected individuals. Several experts recommend considering HIV a cause of secondary osteoporosis.

METHODOLOGY

Were included 52 men living with HIV, classified as high, moderate and low risk using ABRASSO graphic tool.

RESULTS

High risk prevalence found for major fracture and hip fracture were both 2 (4.2 %) using FRAX; while 10 (20.8 %) and 14 (29.2 %) using modified FRAX, respectively. Considering bone densitometry, 5 (12.8 %) were high risk for hip fracture and was noticed an increase in high risk major fracture from 4.2 % with FRAX to 5.1 % with FRAX considering bone densitometry. As for the low risk, 19 (39.6 %) for major fracture and 23 (47.9 %) for hip fracture with FRAX. While low risk modified FRAX were 0 (0 %) for major fracture and 8 (16.7 %) for hip fracture. It was also evidenced an association of high risk for major fracture and hip fracture with modified FRAX using Fisher's exact test [p=0.0273 (bilateral)].

CONCLUSION

It was concluded is recommended using modified FRAX for people living with HIV for better control and therapeutic decision-making about osteometabolic alterations provocated for the virus and ARTs.

Persistently lower bone mass and bone turnover among South African children living with well controlled HIV

OBJECTIVE

We evaluated longitudinal trends and associations between bone mass, bone turnover and inflammatory markers among South African children living with HIV (CLHIV) and controls.

DESIGN

We previously reported decreased bone mass among CLHIV independent of marked inflammation and increased bone turnover. The goal of this study was to evaluate longitudinal changes in bone mass, bone turnover and inflammation over 2 years.

METHODS

Longitudinal analyses were conducted among 220 CLHIV and 220 controls. Anthropometric measurements, physical activity, antiretroviral regimen, virologic and immunologic status, whole body (WB) and lumbar spine (LS) bone mineral content (BMC) and bone mineral density (BMD) were collected (enrollment, 12 and 24 months). Bone turnover markers including C-telopeptide of type I collagen (CTx) and procollagen type I N-terminal propeptide (P1NP) and inflammatory markers including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble CD14 and high-sensitivity C-reactive protein (hsCRP) were collected at enrollment and 24 months.

RESULTS

Compared with controls, CLHIV had significantly lower mean WB-BMC, WB-BMD, WB-BMC z scores, LS-BMC and LS-BMD as well as lower bone formation (P1NP) and resorption (CTx), and higher hsCRP and soluble CD14 over 24 months. CLHIV on efavirenz (EFV) had consistently lower TNF-alpha and IL-6 compared with those on ritonavir-boosted lopinavir (LPV/r) at all time points.

CONCLUSION

Over 2 years of follow-up, South African CLHIV had persistently lower bone mass, bone turnover, and macrophage activation. Lower bone mass and higher pro-inflammatory cytokine profiles were consistently observed among those on LPV/r-based compared with EFV-based regimens.

Synthesis and Characterization of Long-Acting Darunavir Prodrugs

Antiretroviral therapy (ART) has improved the quality of life in patients infected with HIV-1. However, complete viral suppression within anatomical compartments remains unattainable. This is complicated by adverse side effects and poor adherence to lifelong therapy leading to the emergence of viral drug resistance. Thus, there is an immediate need for cellular and tissue-targeted long-acting (LA) ART formulations. Herein, we describe two LA prodrug formulations of darunavir (DRV), a potent antiretroviral protease inhibitor. Two classes of DRV prodrugs, M1DRV and M2DRV, were synthesized as lipophilic and hydrophobic prodrugs and stabilized into aqueous suspensions designated NM1DRV and NM2DRV. The formulations demonstrated enhanced intracellular prodrug levels with sustained drug retention and antiretroviral activities for 15 and 30 days compared to native DRV formulation in human monocyte-derived macrophages. Pharmacokinetics tests of NM1DRV and NM2DRV administered to mice demonstrated sustained drug levels in blood and tissues for 30 days. These data, taken together, support the idea that LA DRV with sustained antiretroviral responses through prodrug nanoformulations is achievable.