Bone Loss Among Women Living With HIV.
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.
The Atlanta Department of Veterans Affairs Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA. mweitzm@emory.edu.|Department of Medicine, Division of Endocrinology and Metabolism and Lipids, Emory University School of Medicine, 101 Woodruff Circle, 1305 WMB, Atlanta, GA, 30322, USA. mweitzm@emory.edu.
M Neale
MN
Weitzmann
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA, 30303, USA.|Grady Healthcare System, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
Ighovwerha
I
Ofotokun
Department of Medicine, Division of Endocrinology and Metabolism and Lipids, Emory University School of Medicine, 101 Woodruff Circle, 1305 WMB, Atlanta, GA, 30322, USA.
Kehmia
K
Titanji
Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Block Bldg #305, Bronx, NY, 10461, USA.
Anjali
A
Sharma
Division of Infectious Diseases, Columbia University Medical Center, 630 West 168th Street, PH8-876, New York, NY, 10032, USA.
Michael T
MT
Yin
D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000139:chemically induced* / Q000150:complications*; D001842:Bone and Bones / Q000187:drug effects*; D005260:Female; D050723:Fractures, Bone; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D011788:Quality of Life
D044966:Anti-Retroviral Agents
ART; Adiposity; Anti-retroviral therapy; B cells; Bone loss; Falls; Fracture; HAART; HIV; OPG; Osteoclasts; Osteoporosis; RANKL; T cells; TNF; cART
Calcif Tissue Int. 2013 Jun;92 (6):557-65
23460340
Clin Infect Dis. 2006 Apr 1;42(7):1014-20
16511769
J Acquir Immune Defic Syndr. 2009 Aug 15;51(5):554-61
19512937
Science. 2000 Sep 1;289(5484):1504-8
10968780
J Clin Endocrinol Metab. 2012 Feb;97(2):554-62
22090266
AIDS. 2016 Jan 28;30(3):405-14
26760232
J Immunol. 1998 Dec 1;161(11):6113-21
9834095
Ann Epidemiol. 2007 Jul;17(7):514-9
17420142
Endocr Rev. 2000 Apr;21(2):115-37
10782361
Clin Infect Dis. 2016 Sep 1;63(5):663-71
27193748
Endocrinology. 2001 Dec;142(12):5050-5
11713196
Med Hypotheses. 2011 Mar;76(3):317-21
20961694
J Acquir Immune Defic Syndr. 2015 Sep 1;70(1):54-61
26322667
Endocrinology. 2002 Mar;143(3):1108-18
11861538
Nat Rev Endocrinol. 2016 Sep;12(9):518-32
27312863
Osteoporos Int. 2002 May;13(5):394-9
12086350
Osteoporos Int. 2005 Apr;16(4):417-23
15776220
Osteoporos Int. 2007 Oct;18(10):1345-53
17665239
J Clin Invest. 2000 Dec;106(12):1481-8
11120755
Nat Commun. 2015 Sep 22;6:8282
26392000
Open Bone J. 2014;6:8-17
25984250
J Acquir Immune Defic Syndr. 2012 Dec 1;61(4):469-76
22895436
J Infect. 2003 May;46(4):221-7
12799147
AIDS. 2010 Nov 13;24(17):2679-86
20859192
PLoS Pathog. 2014 Nov 13;10(10):e1004497
25393853
J Clin Invest. 2003 Apr;111(8):1221-30
12697741
J Investig Med. 2013 Dec;61(8):1178-83
24141238
J Acquir Immune Defic Syndr. 2010 Feb;53(2):202-8
19890216
J Biol Chem. 2001 Jan 5;276(1):563-8
11032840
J Bone Miner Res. 2012 Oct;27(10):2039-46
22836222
Endocr Rev. 2002 Jun;23(3):279-302
12050121
Blood. 2007 May 1;109(9):3839-48
17202317
J Clin Invest. 2000 Nov;106(10):1229-37
11086024
J Clin Endocrinol Metab. 2008 Sep;93(9):3499-504
18593764
Antivir Ther. 2007;12(7):1049-58
18018763
Proc Natl Acad Sci U S A. 2010 Aug 3;107(31):13848-53
20643942
AIDS. 2004 Feb 20;18(3):475-83
15090800
Osteoporos Int. 2005 Nov;16(11):1345-52
15754081