Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

[ABSTRACT:] Recent years have seen an increased risk of bone problems emerge as a potential long-term problem for HIV-infected individuals. Two issues in particular seem to be relevant and different: an apparent increased rate of osteonecrosis and an apparent increased risk of developing osteopenia and osteoporosis. These appear to be separate complications. Osteonecrosis (defined as death of bone tissue usually resulting from circulatory insuffi- ciency) has been described as a complication of HIV-1 infection for many years and usually involves the femoral heads. Although there are many known risk factors, osteonecrosis has been recognized with an apparent increased frequency coincident with the introduction of potent antiretroviral therapy. Case-controlled studies linked osteonecrosis with corticosteroid use and hyperlipidemia, but not with the use of specific antiretroviral drugs. Diagnosis of osteonecrosis can be made by radiographic examination of the femoral head or other involved bone. Surgical resection of involved bone and joint replacement is the only effective therapy. Osteoporosis or bone demineralization was rarely recognized prior to the current era of potent antiretroviral therapy. Previously, marginally lower spine bone mineral density was noted in HIV-1-seropositive men. Initiation of antiretroviral therapy appears to be associated with increased increased bone turnover, which may lead to accelerated bone loss. Many recent reports suggest rates of osteopenia of 20% to 50% and of osteoporosis of 3% to 20% in patients receiving mainly protease inhibitor-containing antiretroviral therapy. Traditional risk factors seem to be important in predicting patients with osteopenia, but the precise role of any specific antiretroviral drugs is unclear. Although to date reports of bone fractures are rare, the long-term consequences of osteopenia in HIV-1-seropositive patients are unknown. Osteoporosis can be diagnosed by radiography or by regional DEXA scanning. The role of therapy for osteopenia is unknown, although if frank osteoporosis is found, and in particular if a pathological fracture occurs in the setting of osteoporosis, appropriate therapy (eg, with a bisphosphonate drug) should be considered.

Presenting author: William Powderly

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1 Washington University School of Medicine, St Louis, USA

2002-11-17
PL13-1

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