ANTI-HIV AGENTS
- Changes to DHHS treatment guidelines—new recommendations for initial HIV therapy
BONE HEALTH
- Guidelines for assessing, preventing and treating low bone density in HIV
- Investigating fracture risk in women with and without HIV
- Menopause, race/ethnicity and changes in bone density
- Backbone fractures and HIV
- A clinical trial of zoledronate for increasing bone density
- A survey about preferences for bone therapy
- Bone health resources
ANTI-HIV AGENTS
Changes to DHHS treatment guidelines—new recommendations for initial HIV therapy
To help guide doctors, nurses and patients when making decisions about the initial use of ART, the U.S. Department of Health and Human Services (DHHS) has been producing treatment guidelines for several decades. In the latest update to the guidelines, medical and scientific advisors to the DHHS have greatly simplified the recommendations for the initial therapy of HIV. This has resulted in just five regimens being recommended.
BONE HEALTH
Guidelines for assessing, preventing and treating low bone density in HIV
HIV-positive people are at increased risk for thinning bones or reduced bone density. A team of doctors and researchers from Australia, Europe, East Asia, Latin America and the U.S. collaborated to develop bone-focused guidelines to assist doctors and nurses caring for HIV-positive people.
Investigating fracture risk in women with and without HIV
To better understand health issues among women who have or are at high risk for HIV, researchers at clinics in key cities in the U.S. have collaborated on a study called WIHS (Women’s Interagency HIV Study, pronounced “wise”). A recent analysis from WIHS sought to understand health-related information collected with a particular focus on fractures. Over an average of 10 years of monitoring, the researchers found that HIV-positive women were more likely to develop fractures than HIV-negative women.
Menopause, race/ethnicity and changes in bone density
Among women who have transitioned through menopause, major shifts in the production of hormones—estrogen and progesterone—have occurred. While these shifts affect fertility, they also affect bone density. Scientists in New York City have been conducting research called the Menopause Study (MS). Just over a decade ago they enrolled women, about half of whom were HIV-positive, and have been monitoring changes to their hormones and health. The latest analysis from MS focused on the complex relationship between race/ethnicity, stages of menopause and bone density.
To explore the presence of backbone fractures in HIV-positive people, doctors in Milan analysed health-related information collected from a fracture-screening program at their clinic. Among 194 participants who underwent assessments of bone density and had X-ray scans of their spine, doctors found that 12% had fractures in their backbone and 9% had deformities arising because of fractures in the spine. Unexpectedly, most fractures (70%) were diagnosed in people who did not have osteoporosis.
A clinical trial of zoledronate for increasing bone density
Researchers in Barcelona, Spain, conducted a clinical trial of zoledronate, one of the drugs that doctors can prescribe to help maintain or increase bone density. Over the course of this two-year study, bone density in the spine of participants who received zoledronate for one year increased by 5%. Among participants who received the drug for two years, bone density increased by 8%. These changes in bone density may seem small but clinical trial data from thousands of HIV-negative people suggest that such increases are associated with a reduced risk for fractures.
A survey about preferences for bone therapy
Researchers have found that when people initiate potent combination anti-HIV therapy (commonly called ART or HAART) their bones can lose some of their density. Some researchers think that this period of initial bone thinning needs to be addressed rather than wait for bone density to fall to critical levels. Toronto-based infectious disease specialist Darrell Tan, MD, and colleagues surveyed HIV-positive patients about their knowledge of bone issues and their willingness to take therapy to maintain or increase their bone density.