Bone Loss Among Women Living With HIV
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Clinical data accumulated over the past two decades attests to a significant decline in bone mineral density (BMD) in patients infected by HIV, which does not remit but may actually intensify with anti-retroviral therapy (ART). Long generally perceived as an aberration without clinical consequences in relatively young HIV-infected cohorts, recent studies have documented marked increases in fracture incidence in HIV-infected men and women over a wide age continuum. Fractures are associated with chronic pain, crippling morbidity, and increased mortality, undermining the gains in quality of life achieved though ART. As bone loss and resulting increases in fracture incidence are a natural consequence of aging, there is now concern regarding the long-term consequences of HIV/ART-associated premature bone loss, given the transition of the HIV/AIDS population into an older age demographic. The development of guidelines for diagnosis and treatment of bone disease within the context of HIV and ART has been an important recent step in raising awareness of the problem and the implications of bone fracture for patient health. Significant progress has also been made in recent years in dissecting the complex and multifactorial mechanisms driving bone loss in HIV/ART and the role of underlying immunological disruption in skeletal dysmorphogenesis. This review examines recent progress in the field and studies by Women’s Interagency HIV Study (WIHS)-associated investigators, inside and outside of the WIHS cohort, aimed at identifying skeletal abnormalities, quantifying facture incidence, management, and understanding underlying mechanisms in people living with HIV in the context of chronic ART.
KeywordsAdiposity Anti-retroviral therapy ART B cells Bone loss cART Falls Fracture HAART HIV OPG Osteoclasts Osteoporosis RANKL T cells TNF
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Conflict of Interest
M. Neale Weitzmann is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) under award numbers R01AR059364 and R01AR070091 and by the National Institute on Aging (NIA) under award number R01AG040013 and is supported by a grant from the Biomedical Laboratory Research & Development Service of the VA Office of Research and Development (5I01BX000105).
Ighovwerha Ofotokun is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) under award numbers R01AR059364 and R01AR070091 and by the National Institute on Aging (NIA) under award number R01AG040013.
Kehmia Titanji is supported by a grant from the Emory University Research Council (URC); has received a grant from the National Heart, Lung, and Blood Institute (NHLBI) under award number K01HL131333; and has received travel support from NIH.
Anjali Sharma is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) under award number K23AR061993.
Michael T. Yin is supported by a grant from the National Institute of Allergy and Infectious Diseases (NIAID) under award number R01AI095089 and has received travel support for WIHS meetings.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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