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Bone density stabilizes in HIV patients on HAART

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – For many patients with HIV receiving highly active antiretroviral therapy (HAART), routine bone mineral density (BMD) assessment may not be necessary because BMD stabilizes or increases over the long term, according to a report in the September issue of the Journal of Clinical Endocrinology and Metabolism online June 29.

The findings come from a meta-analysis of longitudinal studies reporting serial BMD measurements in adult patients with HIV, conducted by Dr. Mark Bolland and colleagues at the University of Auckland, New Zealand. “Taken together,” they write, “our results suggest that low BMD should not be a concern for the majority of younger and middle-aged individuals with HIV, who are adequately treated with antiretroviral therapy and well nourished.”

The authors explain that since weight is a major determinant of BMD, untreated HIV patients with increasing weight loss would be expected to have a decrease in BMD while those on HAART would see increasing BMD as they regain weight. Therefore, HAART status may explain the differing results seen in studies of BMD in HIV patients.

To investigate further, the researchers identified six controlled studies in which BMD measurements in a total of 779 HIV patients were compared with uninfected control, and 31 uncontrolled studies involving a total of 2026 HIV-positive participants.

In the primary analysis using the six controlled studies, all the HIV patients were taking HAART at baseline. During follow-up, there was no significant difference between the change from baseline in BMD at the total hip or femoral neck in HIV-infected cohorts compared with controls, according to the report, while there was a decrease of 0.6% in BMD at the spine in HIV-infected patients compared with controls.

In a secondary analysis that included the uncontrolled studies, the team found that the majority of participants who were on HAART at baseline had stable or increasing BMD at 1 year, and stable or slight decreases in BMD at 2 years. In contrast, the majority of participants who initiated HAART at baseline had significant loss of BMD at 1 year but smaller incremental loss at 2 years.

Summing up, Dr. Bolland and colleagues conclude, “BMD is stable in HIV cohorts established on HAART, whereas cohorts initiating HAART have short-term accelerated BMD loss followed by a longer period of BMD stability/increases.”

They add, “Thus, it may be justified to reconsider current recommendations for lifelong monitoring of BMD every 1–2 years during antiretroviral therapy.”

Reference:
Stable Bone Density in HAART-Treated Individuals with HIV: A Metaanalysis
J Clin Endocrinol Metab 2011;96.