Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Do people with HIV infection have a higher risk of fracture compared with those without HIV infection?

Do people with HIV infection have a higher risk of fracture compared with those without HIV... Purpose of review This review details recent findings that inform the prevalence and incidence of fractures in people living with HIV (PLWH) and examines the effects of HIV infection and antiretroviral therapy (ART), as well as demographics and traditional risk factors on fractures. As antiretroviral guidelines have recently changed to recommend the introduction of ART at diagnosis of HIV infection, the long-term effects of ART on bone health and fracture risk need to be better understood. Recent findings It is apparent that both the effects of HIV infection alone and initiation of ART are associated with significant bone loss in individuals with HIV infection, resulting in osteopenia and osteoporosis. The clinical consequence of low bone mineral density is a greater risk of fragility fractures that are more common in older HIV patients, and those on ART. Frailty occurs at a prevalence of about 10% (about twice that of the general population), and the increased propensity of falls results in greater fracture prevalence, morbidity and mortality. Summary This review examines data from recent cohort studies and clinical trials to inform a better understanding of the complex relationship between the effects of HIV infection, ART and demographics on fractures in PLWH. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Opinion in HIV and AIDS Wolters Kluwer Health

Do people with HIV infection have a higher risk of fracture compared with those without HIV infection?

Hoy, Jennifer; Young, Benjamin
Current Opinion in HIV and AIDS , Volume 11 (3): 301 – May 1, 2016
Download PDF

Do people with HIV infection have a higher risk of fracture compared with those without HIV infection?


INTRODUCTION Antiretroviral therapy (ART) has revolutionized the prognosis for people living with HIV (PLWH). Among PLWH with access to care and treatment, life expectancy is approaching normal and incident morbidity is shifting from AIDS-related disease to the noncommunicable diseases related to aging. Among these, there is a growing awareness that PLWH are at greater risk of metabolic bone disease and fractures. Risks for metabolic bone disease and fractures include non-HIV-related and HIV-related factors. Non-HIV-related risk factors include increasing age, female sex, European or Asian race/ethnicity. Among HIV-related factors, it has been known for some time that initiation of ART is associated with reduction in bone mineral density (BMD) which is more pronounced over the first 12–24 months of treatment, and regardless of ART regimen used. However, the degree of bone loss is greater when regimens including tenofovir disoproxil fumarate and/or protease inhibitors are used. In addition, several cohort studies have suggested that nadir CD4 + cell count may be a significant disease state risk for low BMD and fractures. Recent changes to global HIV treatment guidelines now mean that people diagnosed with HIV infection should be offered ART immediately regardless of CD4 + cell count. The overall benefits of ART both for the health of the individual and the public health benefit of prevention of onward transmission of HIV, outweigh adverse effect of ART on bone health. Bone fractures occur at increased rates in PLWH. Understanding those at greatest risk of fracture will enable interventions to be put in place to prevent them. Box 1 no caption available CHARACTERISTICS OF FRACTURES In order to discuss the risk of bone fractures, it is useful to review the types of fractures as they relate to BMD. Fragility versus nonfragility fractures Fragility fractures are the clinical consequence of significant reductions in BMD. The National Osteoporosis Foundation...
Loading next page...
 
/lp/wolters-kluwer-health/do-people-with-hiv-infection-have-a-higher-risk-of-fracture-compared-kSnElqKum4

References (36)

Publisher
Wolters Kluwer Health
Copyright
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Subject
BONE COMPLICATIONS IN HIV: Edited by Patrick W.G. Mallon and Todd T. Brown
ISSN
1746-630X
eISSN
1746-6318
DOI
10.1097/COH.0000000000000249
pmid
26882459
Publisher site
See Article on Publisher Site

Abstract

Purpose of review This review details recent findings that inform the prevalence and incidence of fractures in people living with HIV (PLWH) and examines the effects of HIV infection and antiretroviral therapy (ART), as well as demographics and traditional risk factors on fractures. As antiretroviral guidelines have recently changed to recommend the introduction of ART at diagnosis of HIV infection, the long-term effects of ART on bone health and fracture risk need to be better understood. Recent findings It is apparent that both the effects of HIV infection alone and initiation of ART are associated with significant bone loss in individuals with HIV infection, resulting in osteopenia and osteoporosis. The clinical consequence of low bone mineral density is a greater risk of fragility fractures that are more common in older HIV patients, and those on ART. Frailty occurs at a prevalence of about 10% (about twice that of the general population), and the increased propensity of falls results in greater fracture prevalence, morbidity and mortality. Summary This review examines data from recent cohort studies and clinical trials to inform a better understanding of the complex relationship between the effects of HIV infection, ART and demographics on fractures in PLWH.

Journal

Current Opinion in HIV and AIDS – Wolters Kluwer Health

Published: May 1, 2016

There are no references for this article.