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Breaking Down Bone Disease in People Living with HIV: Pathophysiology, Diagnosis, and Treatment

Valeria Hasenmajer1, Nicolò Francesco D'Addario2, Ilaria Bonaventura2

  • 1Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. valeria.hasenmajer@uniroma1.it.

Advances in Experimental Medicine and Biology
|December 12, 2024
PubMed

Insights

People with HIV (PLWH) on antiretroviral therapy (ART) face increased risks of osteoporosis and fractures due to viral effects, immune activation, and ART. This review details mechanisms, diagnostics, and management strategies for bone health in PLWH.

Area of Science:

  • Bone Metabolism
  • HIV Pathogenesis
  • Pharmacology

Background:

  • Effective antiretroviral therapy (ART) has shifted HIV infection to a chronic condition.
  • Long-term HIV infection and ART are associated with significant bone health complications.
  • Increased incidence of osteoporosis and fractures observed in people living with HIV (PLWH).

Purpose of the Study:

  • To elucidate multifactorial mechanisms of bone health deterioration in PLWH.
  • To review current evidence on bone mineral density (BMD) reductions and fracture risk.
  • To evaluate diagnostic and management strategies for bone health in PLWH.

Main Methods:

  • Comprehensive literature review of studies on bone health in PLWH.
  • Analysis of mechanisms including direct viral effects, immune activation, and ART-induced changes.
  • Evaluation of diagnostic tools and therapeutic interventions.

Main Results:

  • PLWH exhibit reduced BMD and a heightened risk of fractures.
  • Multifactorial contributors include viral load, immune status, and specific ART regimens.
  • Evidence supports various interventions, including vitamin D optimization and bisphosphonates.

Conclusions:

  • Bone health deterioration is a critical concern for PLWH on ART.
  • Understanding multifactorial mechanisms is key to effective management.
  • Integrated strategies are needed to mitigate bone loss and fracture risk in this population.

Keywords:
BisphosphonatesBone healthHIVOsteoporosisVitamin D

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