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The Aging Skeleton: Differences Between HIV-Infected Patients and the Uninfected Aging Population

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Abstract

In the past 10 years, a great attention has been given to bone metabolism impairment in patients with human immunodeficiency virus (HIV) as a specific organ damage associated with long-term toxicities of antiretroviral therapy. More recently, this issue has been better contextualized in the setting of the overlapping epidemic between HIV and aging. The objective of this review is to describe the aging skeleton as a paradigm of the biological aging process affecting patients with HIV infection. An increased prevalence of osteoporosis and osteopenia has been reported in both men and women infected with HIV, but the mechanism and consequences of these changes are not fully understood. Cohort studies have reported controversial data regarding the increase in fracture rates affecting HIV-infected patients compared with controls. Major determinants of bone mineral density changes over time include antiretroviral therapy exposure, body mass index, and lifestyle. Low CD4 cell count has been associated with fracture risk, suggesting that chronic immune activation and persistent inflammation may play an important role in bone demineralization and fracture development. Whether these findings will apply particularly to older HIV-infected people, who experience a higher chronic inflammation burden and are at highest risk of fragility fractures, is unknown. Definitively, the care of patients with HIV is becoming more complex as patients grow older and confront unique challenges.

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  1. Clinica delle malattie Infettive, Dipartimento di Medicina e Specialità Mediche, Clinica Metabolica, Università degli studi di Modena e Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy

    Giovanni Guaraldi & Antonella Santoro

  2. Infectious Diseases Department, Hospital de Joaquim Urbano, CHP, Porto, Portugal

    Ana Rita Domingues da Silva

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  1. Giovanni Guaraldi
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Correspondence to Giovanni Guaraldi.

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Guaraldi, G., Santoro, A. & da Silva, A.R.D. The Aging Skeleton: Differences Between HIV-Infected Patients and the Uninfected Aging Population. Clinic Rev Bone Miner Metab 10, 257–265 (2012). https://doi.org/10.1007/s12018-012-9138-6

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