HIV therapy affects bone mass within 2 years

By Laura Cowen

Young men receiving antiretroviral therapy (ART) for recently diagnosed HIV are more likely to have low bone mineral density (BMD) than are other men of a similar age, US researchers report.

"None of the young men we saw is in immediate risk of fracture," said lead author Kathleen Mulligan (University of California, San Francisco) in a press statement. "However, our results indicated that it would be a good idea for young men newly diagnosed with HIV to make sure they exercise, get enough calcium and vitamin D, quit smoking and limit alcohol consumption."

This is particularly important because participants' responses to questions about diet and lifestyle indicated that at least half of them did not consume sufficient calcium or vitamin D, more than two-thirds reported alcohol use, and more than 30% smoked. In addition, half said they did not get regular exercise.

Mulligan and team evaluated the association of bone mass with HIV infection and antiretroviral therapy in 199 HIV-positive men and 53 HIV-negative controls, aged 14-25 years - a critical period in terms of achieving peak bone mass.

Of the participants with HIV, 105 were ART-naïve, 52 were on a regimen containing a non-nucleoside reverse transcriptase inhibitor (NNRTI) and 42 were on a regimen containing a protease inhibitor (PI). Median times since HIV diagnosis were 1.3, 1.9, and 2.2 years in the three groups, respectively.

As reported in Clinical Infectious Diseases, men receiving PI had the lowest bone mineral density (BMD), measured by dual-energy X-ray absorptiometry, among the study participants, with Z-scores ranging from -0.67 to -1.19. Compared with HIV negative men and HIV treatment-naïve men, men in the PI group had significantly lower BMD at the total body, total hip, and femoral neck. They also had lower BMD at the spine than treatment-naïve men.

Men receiving NNRTIs had significantly lower BMD than HIV-negative men at the total hip, but not at any of the other sites measured.

Mulligan and co-authors say that their findings are consistent with previous, longer-term studies reporting lower BMD in adults taking certain anti-HIV medication.

"The young men in the [current] study had been taking anti-HIV medications for a comparatively short time, yet they still had lower bone mineral density than other men their age," said study co-author Bill Kapogiannis (National Institute of Child Health and Human Development, Bethesda, Maryland). "These findings suggest a short-term impact of HIV therapy on bone at ages when people are still growing and building bone mass. This raises concern about the risk of fracture as they age."

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