Long-term follow-up of bone loss
As the population of people living with HIV gets older, bone problems are becoming an increasing concern. Low bone mineral density and fragility fractures occur more frequently in people living with HIV than in other people of a similar age. Bone mineral density usually declines in the first two years after starting antiretroviral treatment. Studies have shown that the rate of fractures of the spine, hip and wrist is higher than in the general population.
The reasons for this are unclear. HIV and some of the drugs used to treat it may be two causes, but people living with HIV often have risk factors for bone problems including smoking, high alcohol consumption, low body weight and poor nutrition.
Their results were compared with a larger group of HIV-negative people. However this study did not include a comparison group of people living with HIV who weren’t taking HIV treatment. This means we can’t be sure whether problems are caused by HIV or the drugs used to treat it.
Bone mineral density at the hip and in the lower part of the spine was measured with DEXA scans (a type of X-ray).
For both the hip and spine, bone density fell during the first two years (by 1.5% a year in the hip and 1% a year in the spine). These declines were greater than seen in the comparison group of HIV-negative people.
But the study’s good news is that bone loss did not continue at such a rate after this. During the next five years of follow-up bone density remained the same at the hip. In the spine, it declined at a much slower rate (by 0.3% a year).
People using the drug tenofovir were more likely to have problems.
People who started HIV treatment early, with a high CD4 count, did better.
‘Undetectable’: both a milestone and an identity
In-depth interviews with 25 gay men diagnosed with HIV in British Columbia, Canada suggest that many see achieving an undetectable viral load as an important milestone as they come to terms with having HIV. For example one man said:
“Having an undetectable viral load was the milestone of, number one, accepting that I actually have this condition and number two, taking proactive steps to manage it… In a very vague sort of way, you could say that being undetectable means I am normal again.”
Soon after first learning they had HIV, most of the interviewees either avoided sex or did not have much of a sex drive. When they learnt that they were undetectable (and so highly unlikely to pass HIV on), this opened up new possibilities.
“I didn’t play around when I was not sure… if I was undetectable or not. I didn’t play. They [sexual partners] would be open to it, but I didn’t want… Personally I didn’t feel comfortable, so I didn’t play until I was undetectable.”
Some men incorporated knowledge of their undetectable status into their identities as HIV-positive gay men and their sexual decision making, the researchers say.
Editors' picks from other sources
We’re in an HIV prevention revolution. Where is the excitement?
from CATIE
We’re in the midst of an HIV prevention revolution. So where is the excitement, especially in communities hardest hit by HIV?
Fair pricing coalition sign-on letter to Gilead on pricing of TAF
from TAG
People living with HIV and their healthcare providers welcome the anticipated benefits of substituting tenofovir alafenamide fumarate (TAF) for tenofovir disoproxil fumarate (TDF). We would like to ensure that all people living with HIV have access to these new formulations that may lower the risk of bone and kidney toxicity in accordance with phase III clinical trials.
Having HIV isn't the problem — it’s the negativity around it that stops people getting tested
from Evening Standard
A mistake at a London clinic caused details of patients’ HIV status to be shared with hundreds of strangers. Rob Sherrard’s name was on the list — but he tells Susannah Butter why coming out as positive is actually a relief.