Bone Alterations Associated with HIV
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HIV infection and initiation of antiretroviral therapy (ART) have been consistently associated with decreased bone mineral density (BMD), with growing evidence linking HIV to an increased risk of fracture. This is especially concerning with the expanding number of older persons living with HIV. Interestingly, recent data suggest that HIV-infected children and youth fail to achieve peak BMD, possibly increasing their lifetime risk of fracture. Elucidating the causes of the bone changes in HIV-positive persons is challenging because of the multifactorial nature of bone disease in HIV, including contribution of the virus, immunosuppression, ART toxicity, and traditional osteoporosis risk factors, such as age, lower weight, tobacco, and alcohol use. Thus, practitioners must recognize the risk of low BMD and fractures and appropriately screen patients for osteoporosis if risk factors exist. If fractures do occur or elevated fracture risk is detected through screening, treatment with bisphosphonate medications appears safe and effective in the HIV + population.
KeywordsHIV Bone Osteoporosis Fractures Vitamin D Osteoblasts Children Hepatitis C Treatment Screening Bisphosphonates
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Conflict of Interest
Amy H. Warriner has received research funding from NIH, AHRQ, Astra Zeneca, Bristol-Myers Squibb/Amylin; holds a role on the advisory board for Janssen; and has received payment from ISCD and AACE for lectures. Michael Mugavero reports grants from Bristol Meyers Squibb, grants from Definicare, grants from Pfizer for outside the submitted work; and has received consulting fees from Bristol Meyers Squibb, Merck, and Gilead. E. Turner Overton reports other from Gilead Sciences for outside the submitted work.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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