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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The underlying mechanisms of several bone disorders in human immunodeficiency virus (HIV)-infected persons and any relation to antiretroviral therapy have yet to be defined. A longitudinal study was conducted to estimate the prevalence of osteopenia or osteoporosis in HIV-infected persons; to assess bone mineralization, metabolism, and histomorphometry over time; and to evaluate predisposing factors. A total of 128 patients enrolled the study, and 93 were observed for 72 weeks. "Classic" risk factors (low body mass index, history of weight loss, steroid use, and smoking) for low bone mineral density (BMD) and duration of HIV infection were strongly associated with osteopenia. There was a weak association between low BMD and receipt of treatment with protease inhibitors; this association disappeared after controlling for the above factors. Markers of bone turnover tended to be elevated in the whole cohort but were not associated with low BMD. BMD increased slightly during follow-up. Traditional risk factors and advanced HIV infection play a more significant pathogenic role in the development of osteopenia and osteoporosis associated with HIV infection than do treatment-associated factors.
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PMID:Longitudinal evolution of bone mineral density and bone markers in human immunodeficiency virus-infected individuals. 1256 7

Rheumatic complaints are common in patients with human immunodeficiency virus (HIV) infection. With the advent of the modern combined antiretroviral treatment, life-long control of HIV infection and normalization of life expectancy in HIV-positive patients have become realistic perspectives, but new rheumatic complications, such as osteoporosis, osteonecrosis, gout, and mycobacterial and mycotic osteoarticular infections may be more prevalent. Rheumatologists, internists, and general physicians need to be familiar with the presentation and treatment of these conditions in HIV-positive patients.
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PMID:Rheumatic manifestations of human immunodeficiency virus infection. 1263 5

Osteonecrosis, osteopenia and osteoporosis, hypertension, and mitochondrial toxicity are among the medical conditions observed in patients with HIV disease. In some cases, these disorders have been associated with antiretroviral therapy or particular antiretroviral agents. In other cases, their etiology remains unclear. Meg D. Newman, MD, discussed data from studies of these conditions and current management approaches at the Clinical Pathway of the Ryan White CARE Act 2002 All Grantee Conference held in Washington, DC, in August 2002.
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PMID:Bone disorders, hypertension, and mitochondrial toxicity in HIV disease. 1271 45

Osteopenia and osteoporosis have recently been described as complications of antiretroviral therapy in HIV-infected patients. The advent of highly active antiretroviral therapy in conjunction with improved standard antiviral and antibiotic regimens has dramatically changed the clinical course of HIV infection, resulting in prolonged survival. The pathogenesis and role of each individual medication are poorly understood. Avascular necrosis has also been described in AIDS patients receiving or not receiving antiretroviral therapy. This article is a clinically focused review of the literature on osteopenia, osteoporosis, and mineral metabolism related to HIV infection. In patients with HIV infection, the risks of osteopenia and osteoporosis are not very clear. The suggested risk factors for the development of osteopenia are use of protease inhibitors, longer duration of HIV infection, high viral load, high lactate levels, low bicarbonate levels, raised alkaline phosphatase level, and lower body weight before antiretroviral therapy. There have also been a few case reports of pathologic fractures in AIDS patients with antiretroviral therapy-induced osteopenia and osteoporosis. The underlying mechanism triggering bone loss in HIV-infected patients is unknown. The proinflammatory cytokines tumor necrosis factor and interleukin-6 have been found to be constitutionally produced in increased amounts in HIV-positive individuals, and they may have a role in osteoclast activation and resorption. Serum markers of bone formation are decreased and resorption is increased in patients with advanced clinical disease. Hypocalcemia, hypercalcemia, and abnormalities of the parathyroid hormone axis have been described in HIV infection. Histomorphometric analyses have shown altered bone remodeling in HIV-infected patients when compared with controls. Patients with known risk factors for osteoporosis-advancing age, low body weight, and prolonged duration of HIV infection-and those receiving protease inhibitor treatment should be considered for dual x-ray absorptiometry imaging. If bone mineral density is osteopenic or osteoporotic, then the patient should also be screened for other known medical causes of osteoporosis and consider treatment with a bisphosphonate or, if hypogonadal, testosterone replacement under close monitoring.
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PMID:HIV infection--a risk factor for osteoporosis. 1284 38

Several recent studies add to the evidence that HIV infection and possibly highly active antiretroviral treatment increase risks of bone mass problems among women and children. The research suggests that clinicians should watch for bone density loss and osteoporosis risk factors among the HIV-infected patients.
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PMID:Studies link HIV drugs and bone density problems. Research examining HIV in children and women. 1284 97

An HIV-infected man taking long-term zidovudine and didanosine presented with a polyphenotypic expression of nucleoside reverse transcriptase inhibitor (NRTI)-induced mitochondrial toxicity. Clinical features included lactic acidosis, myopathy, Fanconi-type proximal tubulopathy, pancreatic dysfunction, pseudo-obstruction, mega-oesophagus, peripheral sensory neuropathy and osteoporosis. A muscle biopsy showed morphologically abnormal mitochondria and respiratory chain biochemistry revealed marked reductions in the activity of respiratory chain enzymes containing mitochondrial DNA-encoded subunits. Southern blotting showed no mitochondrial DNA depletion and long PCR revealed only minor deletions. Following withdrawal of NRTI therapy, the lactic acidosis, pancreatic dysfunction and Fanconi's tubulopathy rapidly improved. Over the next 6 months there was marked improvement in osteoporosis, myopathy and neuropathy. At this stage, dual protease inhibitors and nevirapine were started. A repeat muscle biopsy 14 months after presentation showed normal morphology and respiratory chain biochemistry was almost normal.
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PMID:Polyphenotypic expression of mitochondrial toxicity caused by nucleoside reverse transcriptase inhibitors. 1292 44

Although male hypogonadism can adversely affect the well-being of otherwise healthy men, physicians sometimes overlook it as a possible contributing factor to decreased libido, erectile dysfunction (ED), irritability, osteoporosis, and decreased muscle mass. However, hypogonadism is easily treated by testosterone replacement therapy, which may provide benefits such as mood improvement, increased bone density, and possibly reduced risk of type II diabetes. Articles in this supplement focus on populations that may benefit from testosterone replacement therapy (eg, men with type II diabetes, HIV, and ED). An overview of male 'andropause' is also provided. The authors discuss the surprisingly high prevalence of hypogonadism in certain patient populations and its impact on quality of life. Although testosterone has been used therapeutically for years, much remains to be learn about this hormone and its positive effects.
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PMID:Prevalence and management of mild hypogonadism: introduction. 1293 43

Elevating women from the nadir of ovarian hypofunction has been a major driving force in developing hormonal strategies for the management of menopause. As indicated by recent evidence, however, this may have resulted in unacceptable morbidity in several women. Likewise, the use of menstrual cessation as the hallmark of menopause may have served the counterproductive effect of delaying the onset of appropriate preventive pharmacologic and non-pharmacologic strategies until the later years of life. Preventive and therapeutic strategies that target the menopausal phase of life exclusively are grossly inadequate. Unquestionably, the controversies that surround the precise health implications of menopause deal mainly with the risk of chronic disease. Health professionals are best advised to develop menopausal intervention strategies that parallel the continuum of a woman's life, beginning in adolescence and extending into later life. Preventive screening includes the following: History Relevant medical history Develop risk profile of chronic diseases (e.g., cardiovascular disease, cancer, osteoporosis) Dietary history Sexual history Physical exercise history Medication history Physical examination Body mass index evaluation Breast examination and instruction in examination technique Bimanual pelvic examination Nutritional assessment Investigation Cholesterol levels Stool for occult blood Thyroid function tests Papanicolaou smears HIV testing if positive risk factors Psychosocial evaluation Family relationships Job satisfaction Sexuality High-risk social behaviors Review perception of self-health Annual health examination is encouraged in all perimenopausal women. Additionally, preventive screening should be instituted, as appropriate, in all women of reproductive age.
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PMID:Menopause. 1456 3

OSTEOPOROSIS AND OSTEOPENIA: The use of multiple antiretroviral therapies has transformed the prognosis of HIV infection. However, the potential disadvantages of these treatments have rapidly appeared: lipodystrophy, cardiovascular complications and, more recently bone affections with osteonecrosis, followed by other weakening osteopathies (osteoporosis and osteopenia). Osteoporosis is a reduction in bone mineral density (BMD) leading to a high risk of fracture. It is measured by dual energy x-ray absorptiometry and is defined by a T-score<-2.5 standard deviations from the mean value of a young adult. Osteopenia corresponds to low bone density with, avec -1>T-score>-2.5. REGARDING THE AVAILABILITY OF RETROVIRAL AGENTS: During HIV infections, an osteopathy (most often osteopenia) is observed in a quarter to more than half of patients who have never received antiretroviral agents, and in up to three quarters in those in whom treatment in ongoing. The transversal nature of the majority of the studies, the heterogeneity of the treatments, the inclusion of both male and female patients in some studies, and the differences in the results observed do not permit one to draw any conclusions as to the possible responsibility of antiretroviral agents. An association between an osteopathy and a lipodystrophy is inconstant. Lastly, the substitution of a class of a antiretroviral agents by another does not lead to any significant modification in BMD. THE MECHANISM OF OCCURRENCE OF AN OSTEOPATHY: Has not been clearly established. The modifications in serum concentrations of biochemical markers of bone formation and resorption observed in HIV-infected patients and their evolution under antiretroviral treatment, suggest a viral origin, mediated by pro-inflammatory cytokines. The rare in vitro studies, or on animal models, are contradictory, with the results of clinical trials regarding the inherent role of antiretroviral drugs. However, it is probable that the classical risk factors for osteoporosis are often implied.
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PMID:[Osteopathies that weaken HIV-infected patients]. 1471 83

Reduced bone mineral density (BMD) and abnormalities in fat redistribution, glucose homeostasis, and lipid metabolism are prevalent among HIV-infected patients on highly active antiretroviral therapy (HAART). The relationship between the metabolic and skeletal complications of HIV is unclear. Fifty-one HIV patients on HAART (aged 30-54 yr, 86% male) and 21 HIV-negative control subjects (aged 31-51 yr, 82% male) were examined with oral glucose tolerance testing, a fasting lipid profile, and dual x-ray absorptiometry, and markers of bone formation (serum osteocalcin) and resorption (urinary deoxypyridinoline). HIV-infected subjects had a higher prevalence of either osteopenia or osteoporosis (World Health Organization criteria) at the spine, hip, or forearm, compared with HIV-negative controls (63% vs. 32%, P = 0.02) and evidence of increased bone resorption (urine deoxypyridinoline, 14.7 +/- 6.5 vs. 10.9 +/- 2.5 nmol/mmol creatinine, P = 0.012). Among the HIV-infected patients, those with reduced bone mineral density (n = 32) were similar to the group with normal BMD (n = 19) in the use of protease inhibitors, duration of HAART therapy, or other demographic variables. Plasma glucose 2 h after a glucose load (odds ratio 1.02 per 1 mg/dl increase, 95% confidence interval 1.01-1.05, P = 0.009) and central adiposity (trunk fat/total fat) (odds ratio 1.09 per 1% ratio increase, 95% confidence interval 1.00-1.18, P = 0.012) were associated with reduced BMD. These associations remained significant in a multivariate model including age and body mass index. Bone resorption was associated with female gender (P < 0.001) and non-high-density lipoprotein cholesterol (P = 0.034) in a multivariate linear regression model controlling for age, body mass index, protease inhibitor use, duration of HAART, and extremity fat. Reduced BMD is prevalent in HIV-infected patients on HAART and is related to central adiposity and postload hyperglycemia. Bone resorption is independently associated with female gender and dyslipidemia. HIV-infected patients with metabolic abnormalities may represent a population that would benefit from bone density screening.
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PMID:Reduced bone mineral density in human immunodeficiency virus-infected patients and its association with increased central adiposity and postload hyperglycemia. 1500 10


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