Richard Groger (Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO) Erin Quirk (Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO) William G. Powderly (Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO)
Bone disorders have emerged in the last 5 yr as additional long-term complications of human immunodeficiency virus (HIV) infection and its treatment. In particular, multiple studies suggest that HIV-infected patients receiving potent antiretroviral therapy have an increased prevalence of both osteopenia and osteoporosis. Studies prior to the era of potent antiretroviral therapy suggest that HIV infection has a modest effect on bone turnover. Treatment of HIV increases bone turnover with a greater effect on bone resorption. The mechanisms for increased bone demineralization in HIV-infected patients are unclear, although there is some evidence that specific drugs may inhibit bone formation in vitro. Small studies suggest that, in general, bone loss is not progressive over a short period of follow-up, and that the bisphosphonates may be useful in management; however, larger studies are needed to confirm these findings and assess the long-term implications of bone loss in HIV-infected persons.
Clinical Reviews in Bone and Mineral Metabolism Summer 2004, Volume 2, Issue 2, pps. 167-174.