The effects of untreated and treated HIV infection on bone disease

Area of Science:

• Bone metabolism and HIV research
• Immunology and virology
• Antiretroviral therapy (ART) effects

Background:

• Low bone mineral density (BMD) is prevalent in individuals with HIV, linked to increased bone turnover and fracture risk.
• This review examines the mechanisms behind low BMD in HIV, considering its relationship with HIV infection, immune status, and ART.
• Understanding these factors is crucial for managing bone health in the HIV population.

Purpose of the Study:

• To review the underlying mechanisms of low bone mineral density (BMD) in HIV.
• To explore the relationship between low BMD, HIV infection, immune dysfunction, and antiretroviral therapy (ART).
• To propose strategies for mitigating BMD loss in HIV patients.

Main Methods:

• Literature review of studies on BMD in HIV patients.
• Analysis of the impact of HIV viremia and immune status on BMD.
• Examination of the role of antiretroviral therapy (ART) in bone metabolism.

Main Results:

• Significant BMD reductions observed with decreasing HIV viral load during ART initiation.
• Evidence suggests immune- or viral-mediated mechanisms contribute to low BMD pathogenesis.
• ART initiation is associated with changes in BMD, highlighting the interplay between treatment and bone health.

Conclusions:

• Bone metabolism is influenced by T cells and B cells, suggesting immune system involvement in BMD regulation.
• Earlier ART initiation at higher CD4 T-cell counts may prevent BMD loss by reducing immune and viral disturbances.
• Further research is needed to elucidate the complex interactions between HIV, the immune system, ART, and bone metabolism.